Provider Demographics
NPI:1831143783
Name:HUFFMAN, JONATHAN L (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-294-7793
Mailing Address - Fax:828-294-9140
Practice Address - Street 1:1041 MORGANTON BLVD SW
Practice Address - Street 2:SUITE 400
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5605
Practice Address - Country:US
Practice Address - Phone:828-758-8559
Practice Address - Fax:828-294-9160
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0787YOtherBCBS
NC0787YOtherBCBS