Provider Demographics
NPI:1255549275
Name:HUNTER, VANESSA (MT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 SE 25TH LOOP
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1026
Mailing Address - Country:US
Mailing Address - Phone:352-351-0687
Mailing Address - Fax:
Practice Address - Street 1:1328 SE 25TH LOOP
Practice Address - Street 2:SUITE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1026
Practice Address - Country:US
Practice Address - Phone:352-351-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0014544172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5364OtherBLUE CROSS BLUE SHIELD