Provider Demographics
NPI:1366640609
Name:HUBER, MATTHEW THOMAS (ATC/L)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:HUBER
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402B CLARK DR
Mailing Address - Street 2:
Mailing Address - City:HOLMES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34217-1116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:SUITE 511
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4708
Practice Address - Country:US
Practice Address - Phone:813-641-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL21942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer