MEDICARE: TIMOTHY FAY HUNT P.T.

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	2251G0304X	Geriatric Physical Therapist	116341-2401	UT
2	2251X0800X	Orthopedic Physical Therapist	116341-2401	UT

General Provider Information

NPI Number	:	1700125861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY FAY HUNT P.T.

Provider Business Mailing Address
First Line	:	3801 S HIGHLAND COVE LN
Second Line	:	#329
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4223
Country	:	US
Telephone Number	:	801-274-1390
Fax Number	:	801-274-1690

Provider Business Practice Location Address
First Line	:	3801 S HIGHLAND COVE LN
Second Line	:	#329
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-4223
Country	:	US
Telephone Number	:	801-274-1390
Fax Number	:	801-274-1690

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

Provider Enumeration Date	:	02/10/2013
Last Update Date	:	02/10/2013

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