Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21049 | FL |
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1437346830 |
---|---|
Provider Name | Mrs. Shawn Tiffin Hubbard |
First Address | Rome, GA 30162-1975 |
Second Address | Jacksonville, FL 32257-1076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2007 |
Last Update Date | 11/04/2017 |