Healthcare Provider Details

I. General information

NPI: 1619972676
Provider Name (Legal Business Name): MARC HUNLEY RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 144TH AVE STE 102
OMAHA NE
68154-1935
US

IV. Provider business mailing address

625 N 144TH AVE STE 102
OMAHA NE
68154-1935
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-8688
  • Fax: 402-934-8689
Mailing address:
  • Phone: 402-934-8688
  • Fax: 402-934-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2841
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: