Provider Demographics
NPI:1497952451
Name:HUFF, BRENT C (LAT)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:C
Last Name:HUFF
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 THORNWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:520-234-2136
Mailing Address - Fax:
Practice Address - Street 1:525 TYLER RD
Practice Address - Street 2:SUITE J
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3305
Practice Address - Country:US
Practice Address - Phone:630-584-2070
Practice Address - Fax:630-584-2465
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960019972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer