Provider Demographics
NPI:1164129078
Name:HUNTER, ANUCHA PHANSIRI (LMT)
Entity Type:Individual
Prefix:MR
First Name:ANUCHA
Middle Name:PHANSIRI
Last Name:HUNTER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2266
Mailing Address - Country:US
Mailing Address - Phone:754-265-4808
Mailing Address - Fax:
Practice Address - Street 1:2311 NE 9TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2266
Practice Address - Country:US
Practice Address - Phone:754-265-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist