Provider Demographics
NPI:1255481149
Name:HUBER, KEVIN R (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:HUBER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:465 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2613
Mailing Address - Country:US
Mailing Address - Phone:203-879-0107
Mailing Address - Fax:203-879-0206
Practice Address - Street 1:512 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4788
Practice Address - Country:US
Practice Address - Phone:860-343-5997
Practice Address - Fax:860-343-6042
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2671991OtherAETNA ID NUMBER
CT2V4932OtherPHS HEALTHNET PROVIDER ID
CT761899OtherCONNECTICARE
CT6404276OtherUHC PROVIDER ID
CT080006452CT01OtherBLUE CROSS BLUE SHIELD
CTP3665127OtherOXFORD PROVIDER ID
CTP3665127OtherOXFORD PROVIDER ID
CT2V4932OtherPHS HEALTHNET PROVIDER ID