Provider Demographics
NPI:1558576553
Name:HUBBUCK, SUSAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HUBBUCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5857 W 117TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5973
Mailing Address - Country:US
Mailing Address - Phone:303-466-6073
Mailing Address - Fax:
Practice Address - Street 1:5857 W 117TH PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-5973
Practice Address - Country:US
Practice Address - Phone:303-883-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28662251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics