Provider Demographics
NPI:1164105474
Name:HUNTON, KOLIN
Entity Type:Individual
Prefix:
First Name:KOLIN
Middle Name:
Last Name:HUNTON
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 1:1504 S 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3327
Mailing Address - Country:US
Mailing Address - Phone:406-240-4547
Mailing Address - Fax:
Practice Address - Street 1:945 WYOMING ST UNIT 135
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2057
Practice Address - Country:US
Practice Address - Phone:406-370-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTPPTLIC27203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist