Provider Demographics
NPI:1710258272
Name:HUNT, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 MONO DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2118
Mailing Address - Country:US
Mailing Address - Phone:951-369-6507
Mailing Address - Fax:951-369-6503
Practice Address - Street 1:33492 OAK GLEN RD
Practice Address - Street 2:SUITE H
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2096
Practice Address - Country:US
Practice Address - Phone:800-644-2966
Practice Address - Fax:909-363-8574
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 5064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist