Provider Demographics
NPI:1568709251
Name:HUNTER, RICKY MEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:MEL
Last Name:HUNTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2275 BECKENHAM PL
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6746
Mailing Address - Country:US
Mailing Address - Phone:404-307-8622
Mailing Address - Fax:770-965-4257
Practice Address - Street 1:5373 THOMPSON MILL RD
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4037
Practice Address - Country:US
Practice Address - Phone:678-866-8690
Practice Address - Fax:770-965-4257
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000488225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant