Provider Demographics
NPI:1295888618
Name:HUNNICUTT, DIANA KANE (PT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:KANE
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 ACADEMY HILLS DR NE
Mailing Address - Street 2:HUBERT HUMPHREY ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1311
Mailing Address - Country:US
Mailing Address - Phone:505-821-4981
Mailing Address - Fax:
Practice Address - Street 1:9801 ACADEMY HILLS DR NE
Practice Address - Street 2:HUBERT HUMPHREY ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1311
Practice Address - Country:US
Practice Address - Phone:505-821-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68815Medicaid