Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | J2-0011478 | DE |
NPI | 1003571100 |
---|---|
Provider Name | Phillip Huber |
First Address | Dover, DE 19901-6932 |
Second Address | Dover, DE 19901-6932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2021 |
Last Update Date | 03/11/2021 |