Provider Demographics
NPI:1689235145
Name:MASHBURN, HUNTER MCKENZIE (PTA)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:MCKENZIE
Last Name:MASHBURN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3066
Mailing Address - Country:US
Mailing Address - Phone:704-267-3417
Mailing Address - Fax:
Practice Address - Street 1:548 WHITE OAKS DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-8183
Practice Address - Country:US
Practice Address - Phone:980-643-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant