Provider Demographics
NPI:1619224060
Name:HUBERT, PATRICIA LYNN (CMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:HUBERT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18598 WOODDUCK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2900
Mailing Address - Country:US
Mailing Address - Phone:616-850-0580
Mailing Address - Fax:
Practice Address - Street 1:19082 N FRUITPORT RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1163
Practice Address - Country:US
Practice Address - Phone:616-850-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist