Provider Demographics
NPI:1437346830
Name:HUBBARD, SHAWN TIFFIN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:TIFFIN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1975
Mailing Address - Country:US
Mailing Address - Phone:904-619-5831
Mailing Address - Fax:866-225-4350
Practice Address - Street 1:10660 OLD SAINT AUGUSTINE RD STE PT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1076
Practice Address - Country:US
Practice Address - Phone:904-619-5831
Practice Address - Fax:866-225-4350
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21049225100000X
2251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIV842ZMedicare PIN
FLIV842YMedicare PIN