Healthcare Provider Details

I. General information

NPI: 1114656410
Provider Name (Legal Business Name): MARTINE HUNNICUTT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8226 MEADOWBRIDGE RD
MECHANICSVILLE VA
23116-2331
US

IV. Provider business mailing address

101 S ROBINSON ST APT 1209
RICHMOND VA
23220-5164
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-1000
  • Fax:
Mailing address:
  • Phone: 757-813-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215133
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: