Provider Demographics
NPI:1639441454
Name:HUNTER, MATTHEW GLENN (ATC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GLENN
Last Name:HUNTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EAST STOUT AVE.
Mailing Address - Street 2:PO BOX 262
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466
Mailing Address - Country:US
Mailing Address - Phone:859-582-5602
Mailing Address - Fax:
Practice Address - Street 1:30 CAMPUS ROAD
Practice Address - Street 2:
Practice Address - City:ANNANDALE-ON-HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12504
Practice Address - Country:US
Practice Address - Phone:845-758-7694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001936-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer