Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1552 | ND |
N | 2251G0304X | Physical Therapist - Geriatrics | 1552 | ND |
N | 2251N0400X | Physical Therapist - Neurology | 1552 | ND |
N | 2251X0800X | Physical Therapist - Orthopedic | 1552 | ND |
NPI | 1598173288 |
---|---|
Provider Name | Matthew Huber |
First Address | Fargo, ND 58104-3400 |
Second Address | Fargo, ND 58104-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2014 |
Last Update Date | 26/07/2014 |