1366513533 NPI number — MR. LEA ADAM HUNT PT., DPT.,COMT

Table of content: MR. LEA ADAM HUNT PT., DPT.,COMT (NPI 1366513533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366513533 NPI number — MR. LEA ADAM HUNT PT., DPT.,COMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNT
Provider First Name:
LEA
Provider Middle Name:
ADAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT., DPT.,COMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366513533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85060-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-385-2115
Provider Business Mailing Address Fax Number:
480-418-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2940 E BANNER GATEWAY DR STE 200-250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-964-2908
Provider Business Practice Location Address Fax Number:
480-833-2136
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5814 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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