Provider Demographics
NPI:1477986735
Name:HUBER, JILL (PTA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MEDICAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4972
Mailing Address - Country:US
Mailing Address - Phone:936-294-0283
Mailing Address - Fax:
Practice Address - Street 1:127 MEDICAL PARK LN
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4972
Practice Address - Country:US
Practice Address - Phone:936-294-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2088566225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant