Basic Information
Provider Information
NPI: 1063022572
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNKER
FirstName: RYAN
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MEDICAL PARK
Address2:  
City: WHEELING
State: WV
PostalCode: 260036300
CountryCode: US
TelephoneNumber: 3042433124
FaxNumber: 3042431131
Practice Location
Address1: 1 MEDICAL PARK
Address2:  
City: WHEELING
State: WV
PostalCode: 260036300
CountryCode: US
TelephoneNumber: 3042433124
FaxNumber: 3042431131
Other Information
ProviderEnumerationDate: 08/10/2020
LastUpdateDate: 08/10/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT013047OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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