Active NPI
Charles Allen Hubbard, PT
- Specialist
- Bonne Terre, MO
National Provider Identifier
1437341583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- R0530
- Practice address
- 513 E Capri Dr
Bonne Terre, MO 63628-9331 - Phone
- (573) 358-7356
- Fax
- (573) 358-7356
- NPI assigned
- Aug 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | R0530 | MO | Primary |
Addresses
Primary practice location
513 E Capri Dr
Bonne Terre, MO 63628-9331
Mailing address
513 E Capri Dr
Bonne Terre, MO 63628-9331
Phone (573) 358-7356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0530 | MO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186963200000",
"number": "1437341583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "513 E CAPRI DR",
"city": "BONNE TERRE",
"state": "MO",
"postal_code": "636289331",
"telephone_number": "573-358-7356",
"fax_number": "573-358-7356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "513 E CAPRI DR",
"city": "BONNE TERRE",
"state": "MO",
"postal_code": "636289331",
"telephone_number": "573-358-7356",
"fax_number": "573-358-7356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBBARD",
"first_name": "CHARLES",
"middle_name": "ALLEN",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-13",
"last_updated": "2007-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MO",
"license": "R0530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonne Terre, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.