Provider Demographics
NPI:1902062367
Name:HUBBARD, NACHELLE LORRAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NACHELLE
Middle Name:LORRAINE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3411
Mailing Address - Country:US
Mailing Address - Phone:901-853-0985
Mailing Address - Fax:800-694-0938
Practice Address - Street 1:380 MILITARY RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3411
Practice Address - Country:US
Practice Address - Phone:901-853-0985
Practice Address - Fax:800-694-0938
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000003936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist