Provider Demographics
NPI:1932205622
Name:HUNT, SUSAN KAYE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAYE
Last Name:HUNT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-9116
Mailing Address - Country:US
Mailing Address - Phone:405-454-0010
Mailing Address - Fax:405-454-0030
Practice Address - Street 1:19629 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9305
Practice Address - Country:US
Practice Address - Phone:405-454-0010
Practice Address - Fax:405-454-0030
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
70-0522179Medicare ID - Type Unspecified