Provider Demographics
NPI:1164837662
Name:SUSSKY, HUNTER
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:SUSSKY
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 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1916
Mailing Address - Fax:630-928-5016
Practice Address - Street 1:781 S MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7444
Practice Address - Country:US
Practice Address - Phone:815-455-7800
Practice Address - Fax:815-455-1299
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist