Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160005055 | IL |
NPI | 1003480104 |
---|---|
Provider Name | Dartanion C. Hunt |
First Address | Champaign, IL 61822-3753 |
Second Address | Champaign, IL 61822-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2021 |
Last Update Date | 13/05/2021 |