Provider Demographics
NPI:1265265961
Name:HOUSTON, HUNTER (DPT)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 SW BARNETT WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6953
Mailing Address - Country:US
Mailing Address - Phone:386-752-7332
Mailing Address - Fax:386-752-5256
Practice Address - Street 1:1852 SW BARNETT WAY STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6953
Practice Address - Country:US
Practice Address - Phone:239-432-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist