Provider Demographics
NPI:1518375971
Name:HUBBARD, DUSTIN (PTA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9407
Mailing Address - Country:US
Mailing Address - Phone:870-793-3200
Mailing Address - Fax:
Practice Address - Street 1:200 GENERAL ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9407
Practice Address - Country:US
Practice Address - Phone:870-793-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant