Provider Demographics
NPI:1629029087
Name:HUNTER, CHRISTOPHER M (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:HUNTER
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 1:5001 SHERIDAN ST
Mailing Address - Street 2:UNIT D #87
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4143
Mailing Address - Country:US
Mailing Address - Phone:563-359-9405
Mailing Address - Fax:
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:SUITE 203
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-332-9312
Practice Address - Fax:563-332-9316
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03376225100000X
IL070-012574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-012574OtherILLINOIS PT LICENSE NO
IA0665257Medicaid
IA03376OtherIOWA PT LICENSE NUMBER