Provider Demographics
NPI:1427015395
Name:HUNT, ZACHARY SHANE (MSPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SHANE
Last Name:HUNT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:855-498-6766
Mailing Address - Fax:
Practice Address - Street 1:505 W PERSHING BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2147
Practice Address - Country:US
Practice Address - Phone:501-812-4970
Practice Address - Fax:501-812-4972
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W842Medicare ID - Type UnspecifiedPROVIDER NUMBER