Provider Demographics
NPI:1184710923
Name:HUNT, GLEN EDWARD (ATC/PTA)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:EDWARD
Last Name:HUNT
Suffix:
Gender:M
Credentials:ATC/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2504
Mailing Address - Country:US
Mailing Address - Phone:704-630-9656
Mailing Address - Fax:704-630-9658
Practice Address - Street 1:1508 W INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2504
Practice Address - Country:US
Practice Address - Phone:704-630-9656
Practice Address - Fax:704-630-9658
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12012255A2300X
NCA3598225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer