Provider Demographics
NPI:1255811022
Name:HUBERT, LATECIA RENEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:LATECIA
Middle Name:RENEE
Last Name:HUBERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:LATECIA
Other - Middle Name:RENEE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:813 DICKENS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5707
Mailing Address - Country:US
Mailing Address - Phone:254-640-5577
Mailing Address - Fax:
Practice Address - Street 1:503 MEADOW DR
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1018
Practice Address - Country:US
Practice Address - Phone:254-826-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2088990225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant