Provider Demographics
NPI:1275047961
Name:HUEBNER, ANGELA BLALOCK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BLALOCK
Last Name:HUEBNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:BAILEY
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:103 DAVIS RD STE M
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2769
Mailing Address - Country:US
Mailing Address - Phone:281-338-6777
Mailing Address - Fax:281-338-6778
Practice Address - Street 1:103 DAVIS RD STE M
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2769
Practice Address - Country:US
Practice Address - Phone:281-338-6777
Practice Address - Fax:281-338-6778
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1294815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty