Provider Demographics
NPI:1639149503
Name:HUNNICUTT, HOLLY (PT)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 WADE AVENUE
Mailing Address - Street 2:#139
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4048
Mailing Address - Country:US
Mailing Address - Phone:919-782-5954
Mailing Address - Fax:919-859-9444
Practice Address - Street 1:2418 BLUE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6480
Practice Address - Country:US
Practice Address - Phone:919-782-5954
Practice Address - Fax:919-859-9444
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5947795OtherAETNA
NC184835OtherMEDCOST
NC0781TOtherBLUE CROSS BLUE SHIELD
NC2503970BMedicare ID - Type Unspecified