Provider Demographics
NPI:1669248688
Name:HUBER, NANCY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:HUBER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-2829
Mailing Address - Country:US
Mailing Address - Phone:636-399-3664
Mailing Address - Fax:
Practice Address - Street 1:831 W PRIDE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-1208
Practice Address - Country:US
Practice Address - Phone:636-231-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115728225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant