Provider Demographics
NPI:1730571878
Name:HUNTER, JAMES GLENN (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GLENN
Last Name:HUNTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22034 MIRADOR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-1136
Mailing Address - Country:US
Mailing Address - Phone:805-252-5779
Mailing Address - Fax:
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3189
Practice Address - Country:US
Practice Address - Phone:949-333-3833
Practice Address - Fax:949-390-8770
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist