Provider Demographics
NPI:1629063060
Name:HUBBARD, JONICA LEE
Entity Type:Individual
Prefix:MS
First Name:JONICA
Middle Name:LEE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 TRAP FALLS RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4616
Mailing Address - Country:US
Mailing Address - Phone:203-734-7900
Mailing Address - Fax:203-513-3267
Practice Address - Street 1:2 TRAP FALLS RD
Practice Address - Street 2:SUITE 404
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-734-7900
Practice Address - Fax:203-513-3267
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer