Provider Demographics
NPI:1629065917
Name:HUBBARD, MEGAN M (LAT,ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 S OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3082
Mailing Address - Country:US
Mailing Address - Phone:812-334-0414
Mailing Address - Fax:
Practice Address - Street 1:1101 N FEE LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47406-7502
Practice Address - Country:US
Practice Address - Phone:812-855-4509
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001101A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer