Basic Information
| Provider Information | |||||||||
| NPI: | 1023596681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNT | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17034 ECHO LAKE DR | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234306970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574043538 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1015 W 47TH ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235290001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576837041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2018 | ||||||||
| LastUpdateDate: | 08/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305212194 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.