Provider Demographics
NPI:1407935570
Name:HUEBNER, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HUEBNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 CALIFORNIA ST APT 79
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1765
Mailing Address - Country:US
Mailing Address - Phone:650-201-6038
Mailing Address - Fax:
Practice Address - Street 1:299 S CALIFORNIA AVE STE 300
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1915
Practice Address - Country:US
Practice Address - Phone:650-331-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5893OtherLICENSE#