Provider Demographics
NPI:1912496589
Name:WHITTEN, HUNT MADDOX (LAT, ATC, EMT)
Entity type:Individual
Prefix:
First Name:HUNT
Middle Name:MADDOX
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:LAT, ATC, EMT
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4008 LOUETTA RD # 271
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4362 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4411
Practice Address - Country:US
Practice Address - Phone:281-380-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT51102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer