Provider Demographics
NPI:1184748345
Name:HULNICK, KENT JOSHUA
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:JOSHUA
Last Name:HULNICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KENT
Other - Middle Name:JOSHUA
Other - Last Name:HULNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:1414 ESPLANADE CT
Mailing Address - Street 2:#147
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1259
Mailing Address - Country:US
Mailing Address - Phone:703-668-0079
Mailing Address - Fax:
Practice Address - Street 1:11400 S LAKES DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4102
Practice Address - Country:US
Practice Address - Phone:703-715-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer