Provider Demographics
NPI:1295902369
Name:HUEBNER, KENNETH (PT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HUEBNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 DYNASTY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6841
Mailing Address - Country:US
Mailing Address - Phone:561-213-5855
Mailing Address - Fax:561-369-3544
Practice Address - Street 1:1101 N CONGRESS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3336
Practice Address - Country:US
Practice Address - Phone:561-736-0294
Practice Address - Fax:561-369-3544
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23455261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy