1598835720 NPI number — RHONDA A. HUBBERSTEY PT

Table of content: RHONDA A. HUBBERSTEY PT (NPI 1598835720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598835720 NPI number — RHONDA A. HUBBERSTEY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBBERSTEY
Provider First Name:
RHONDA
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OWENS
Provider Other First Name:
RHONDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598835720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
771 PILOT HOUSE DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-873-2302
Provider Business Mailing Address Fax Number:
757-873-2302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2106 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-838-6678
Provider Business Practice Location Address Fax Number:
757-838-8116
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00009261 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2305208598 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00263401 . This is a "RAILROAD MEDICARE PC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8939738 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00264721 . This is a "RAILROAD MED KING COUNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1598835720 . This is a "MEDICAID QMB PROVIDER ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8414773 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8026OW . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 193238 . This is a "DEPT OF LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: C05954 . This is a "GROUP MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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