Provider Demographics
NPI:1588185409
Name:HUBACHER, DWIGHT DAVID
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:DAVID
Last Name:HUBACHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-5078
Mailing Address - Country:US
Mailing Address - Phone:434-249-2229
Mailing Address - Fax:
Practice Address - Street 1:162 ACADEMY STRRET
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769
Practice Address - Country:US
Practice Address - Phone:207-764-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4866225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA4866OtherNURSING HOME