Individual
MR. BLAZE B HUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 CONGRESS AVE, STE L-VAULTS, AUSTIN, TX 78701-2437
(512) 467-1100
Mailing address
4101A VALLEY VIEW RD, AUSTIN, TX 78704-7994
(512) 913-4743
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2074248
TX
225700000X
Massage Therapist
MT046366
TX
Other
Enumeration date
08/03/2010
Last updated
07/23/2013
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