Healthcare Provider Details

I. General information

NPI: 1235986019
Provider Name (Legal Business Name): DONAVAN HUHN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

396 BERTUCCI BLVD
BILOXI MS
39531-2262
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5000
  • Fax:
Mailing address:
  • Phone: 601-740-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA6025
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: