Healthcare Provider Details

I. General information

NPI: 1902953698
Provider Name (Legal Business Name): MONA S HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 OVERTON CROSSING ST
MEMPHIS TN
38127-7312
US

IV. Provider business mailing address

3048 OVERTON CROSSING ST
MEMPHIS TN
38127-7312
US

V. Phone/Fax

Practice location:
  • Phone: 901-353-2696
  • Fax:
Mailing address:
  • Phone: 901-353-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2945
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: