Healthcare Provider Details

I. General information

NPI: 1962738757
Provider Name (Legal Business Name): JAMES BRYAN HUNTER LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17510 NE 3RD ST
VANCOUVER WA
98684-3731
US

IV. Provider business mailing address

222 NE 4TH AVE
CAMAS WA
98607-2124
US

V. Phone/Fax

Practice location:
  • Phone: 641-233-0985
  • Fax:
Mailing address:
  • Phone: 641-233-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60103752
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: