Provider Demographics
NPI:1174255210
Name:HUBBARD-HOLDEN, KALEAB MYCHEAL DAMIEN (PTA)
Entity Type:Individual
Prefix:
First Name:KALEAB
Middle Name:MYCHEAL DAMIEN
Last Name:HUBBARD-HOLDEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MOORE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8770
Mailing Address - Country:US
Mailing Address - Phone:336-673-6490
Mailing Address - Fax:
Practice Address - Street 1:167 MOORE RD STE 203
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8770
Practice Address - Country:US
Practice Address - Phone:336-673-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA72162081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine