Provider Demographics
NPI:1679026496
Name:HUTTO, HILLARY LEANNE (DPT)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:LEANNE
Last Name:HUTTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:LEANNE
Other - Last Name:BLAYLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 MARKET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6913
Mailing Address - Country:US
Mailing Address - Phone:901-861-9970
Mailing Address - Fax:901-861-9971
Practice Address - Street 1:1112 HIGHWAY 278 E STE A
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5626
Practice Address - Country:US
Practice Address - Phone:662-257-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCP010405T225100000X
TN12083225100000X
MSPT5985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS521948YNB2Medicare Oscar/Certification