Healthcare Provider Details

I. General information

NPI: 1760585020
Provider Name (Legal Business Name): CARL BRADLEY HUFF JR. MS,LAT,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 COLLEGE ST
BANNER ELK NC
28604
US

IV. Provider business mailing address

527 LOWER TOWER RD
NEWLAND NC
28657-9581
US

V. Phone/Fax

Practice location:
  • Phone: 828-898-3193
  • Fax:
Mailing address:
  • Phone: 828-898-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: