Individual
EVAN HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1011 A 10TH STREET, ALAMOGORDO, NM 88310
(575) 439-9878
(575) 439-9876
Mailing address
8428 CEDAR CREEK PL NW, ALBUQUERQUE, NM 87120-3874
(575) 439-9878
(575) 439-9876
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1187
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-1187
PTA LICENSE
NM
Enumeration date
10/29/2015
Last updated
10/29/2015
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