Provider Demographics
NPI:1700389871
Name:HUNT, STEVEN LAWRENCE (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LAWRENCE
Last Name:HUNT
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 1:2714 EASTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4546
Mailing Address - Country:US
Mailing Address - Phone:505-801-5264
Mailing Address - Fax:
Practice Address - Street 1:2714 EASTRIDGE CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4546
Practice Address - Country:US
Practice Address - Phone:505-801-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008187225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant