Provider Demographics
NPI:1629783667
Name:HUBBARD, HENRY III (MT)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:HUBBARD
Suffix:III
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 20TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4900
Mailing Address - Country:US
Mailing Address - Phone:504-344-6498
Mailing Address - Fax:
Practice Address - Street 1:3008 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4900
Practice Address - Country:US
Practice Address - Phone:504-344-6498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist