Provider Demographics
NPI:1174582241
Name:KUNKEL, LAURA E (MS, LAT, ATC, PES)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:MS, LAT, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 BONNET CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-5319
Mailing Address - Country:US
Mailing Address - Phone:817-471-4461
Mailing Address - Fax:
Practice Address - Street 1:8513 BONNET CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-5319
Practice Address - Country:US
Practice Address - Phone:817-471-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT45972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer