Provider Demographics
NPI:1366842478
Name:HUBBARD, REBECCA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT ATC
Mailing Address - Street 1:805 N MILAM ST
Mailing Address - Street 2:A
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-1413
Mailing Address - Country:US
Mailing Address - Phone:512-964-7424
Mailing Address - Fax:
Practice Address - Street 1:805 N MILAM ST
Practice Address - Street 2:A
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-1413
Practice Address - Country:US
Practice Address - Phone:512-964-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT58762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer