Provider Demographics
NPI:1649229162
Name:LUNT, SAMUEL DAVID (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:DAVID
Last Name:LUNT
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9093 COPPERFAIR LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8196
Mailing Address - Country:US
Mailing Address - Phone:850-878-8125
Mailing Address - Fax:850-644-6223
Practice Address - Street 1:9093 COPPERFAIR LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-8196
Practice Address - Country:US
Practice Address - Phone:850-878-8125
Practice Address - Fax:850-644-6223
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 2242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer