Provider Demographics
NPI:1427489061
Name:HUNTER, ANTHONY DWAYNE JR (ATC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DWAYNE
Last Name:HUNTER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 15TH AVE SE
Mailing Address - Street 2:APT B
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6634
Mailing Address - Country:US
Mailing Address - Phone:816-935-2308
Mailing Address - Fax:
Practice Address - Street 1:211 DIXON RECREATION CTR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8501
Practice Address - Country:US
Practice Address - Phone:541-737-9348
Practice Address - Fax:541-737-6832
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10159766390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program