Healthcare Provider Details

I. General information

NPI: 1356262042
Provider Name (Legal Business Name): MATTHEW COULTER HUNSAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 65 BOX 33427
CONCHO AZ
85924-8507
US

IV. Provider business mailing address

HC 65 BOX 33427
CONCHO AZ
85924-8507
US

V. Phone/Fax

Practice location:
  • Phone: 928-963-0721
  • Fax:
Mailing address:
  • Phone: 928-963-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-18211
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: