Provider Demographics
NPI:1609582410
Name:HILLABUSH, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HILLABUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 111TH PL N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2105
Mailing Address - Country:US
Mailing Address - Phone:727-405-9677
Mailing Address - Fax:
Practice Address - Street 1:430 MORTON PLANT ST STE 301
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3395
Practice Address - Country:US
Practice Address - Phone:727-461-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant