MEDICARE: ZACHARY SHANE HUNT MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2550	AR

General Provider Information

NPI Number	:	1427015395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY SHANE HUNT MSPT

Provider Business Mailing Address
First Line	:	PO BOX 9178
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72811-9178
Country	:	US
Telephone Number	:	855-498-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W PERSHING BLVD
Second Line	:	SUITE D
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2147
Country	:	US
Telephone Number	:	501-812-4970
Fax Number	:	501-812-4972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	12/20/2013

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