Provider Demographics
NPI:1457391393
Name:HUBER, STEVEN RAY (PT/ORTHOTIST/CKTI)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:HUBER
Suffix:
Gender:M
Credentials:PT/ORTHOTIST/CKTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 MINOT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4052
Mailing Address - Country:US
Mailing Address - Phone:207-783-3393
Mailing Address - Fax:207-783-0848
Practice Address - Street 1:637 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4052
Practice Address - Country:US
Practice Address - Phone:207-783-3393
Practice Address - Fax:207-783-0848
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117750199Medicaid
ME002634OtherANTHEM BCBS
650014315Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ME002634OtherANTHEM BCBS