Healthcare Provider Details

I. General information

NPI: 1235122839
Provider Name (Legal Business Name): ERIC DWIGHT HUFFMAN PT, BS, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 LONG PRAIRIE RD #600
FLOWER MOUND TX
75028-5613
US

IV. Provider business mailing address

6050 LONG PRAIRIE RD #600
FLOWER MOUND TX
75028-5613
US

V. Phone/Fax

Practice location:
  • Phone: 972-539-5795
  • Fax: 972-539-5793
Mailing address:
  • Phone: 972-539-5795
  • Fax: 972-539-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1115194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: