Provider Demographics
NPI:1487083549
Name:HUBBS, SHANDREA JEAN (DPT)
Entity type:Individual
Prefix:MRS
First Name:SHANDREA
Middle Name:JEAN
Last Name:HUBBS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 HOUNDSLAKE DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5924
Mailing Address - Country:US
Mailing Address - Phone:971-344-1024
Mailing Address - Fax:803-845-4793
Practice Address - Street 1:920 HOUNDSLAKE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5924
Practice Address - Country:US
Practice Address - Phone:803-716-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8984225100000X, 2251X0800X
OR602372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist