Provider Demographics
NPI:1659727626
Name:HUBBARD, CHARLES MCKIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MCKIE
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:151 FLY CREEK AVE
Practice Address - Street 2:STE 438
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-8307
Practice Address - Country:US
Practice Address - Phone:251-928-9619
Practice Address - Fax:251-928-9621
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist