Provider Demographics
NPI:1649353459
Name:HUBBARD, ELIZABETH A (ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:COUVREUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1656 BENNINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1775
Mailing Address - Country:US
Mailing Address - Phone:734-398-5569
Mailing Address - Fax:
Practice Address - Street 1:690 AMSTERDAM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3410
Practice Address - Country:US
Practice Address - Phone:313-651-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer