Provider Demographics
NPI:1306926050
Name:HUITT, RONALD ALLEN (PT, CERT MDT, CSCS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ALLEN
Last Name:HUITT
Suffix:
Gender:M
Credentials:PT, CERT MDT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-0494
Mailing Address - Country:US
Mailing Address - Phone:931-823-1200
Mailing Address - Fax:931-823-1209
Practice Address - Street 1:7385 BRADFORD HICKS DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-2239
Practice Address - Country:US
Practice Address - Phone:931-823-1200
Practice Address - Fax:931-823-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051351OtherBLUE CROSS BLUE SHIELD
TN446587Medicare ID - Type Unspecified