Basic Information
| Provider Information | |||||||||
| NPI: | 1295206977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNT | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | KATHLENE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DRY | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | KATHLENE | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6301 TRANSIT RD | ||||||||
| Address2: | |||||||||
| City: | DEPEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140431051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166840400 | ||||||||
| FaxNumber: | 7166837023 | ||||||||
| Practice Location | |||||||||
| Address1: | 4039 ROUTE 219 | ||||||||
| Address2: | |||||||||
| City: | SALAMANCA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169452484 | ||||||||
| FaxNumber: | 7169452487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2018 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 041793 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.