Basic Information
| Provider Information | |||||||||
| NPI: | 1598835720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUBBERSTEY | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | OWENS | ||||||||
| OtherFirstName: | RHONDA | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 771 PILOT HOUSE DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236061990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732302 | ||||||||
| Practice Location | |||||||||
| Address1: | 2106 EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236662402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578386678 | ||||||||
| FaxNumber: | 7578388116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 11/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009261 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305208598 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00263401 | 01 | WA | RAILROAD MEDICARE PC | OTHER | 8939738 | 01 | WA | CRIME VICTIMS | OTHER | P00264721 | 01 | WA | RAILROAD MED KING COUNTY | OTHER | 1598835720 | 01 | VA | MEDICAID QMB PROVIDER ID | OTHER | 8414773 | 05 | WA | MEDICAID | 8026OW | 01 | WA | REGENCE BLUE SHIELD | OTHER | 193238 | 01 | WA | DEPT OF LABOR & INDUSTRY | OTHER | C05954 | 01 | VA | GROUP MEDICARE PTAN | OTHER |