Provider Demographics
NPI:1235779224
Name:KUNZ, DUSTIN
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:KUNZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WHITE SAGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-5555
Mailing Address - Country:US
Mailing Address - Phone:435-864-2551
Mailing Address - Fax:435-864-3573
Practice Address - Street 1:95 WHITE SAGE AVE STE C
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-5555
Practice Address - Country:US
Practice Address - Phone:435-864-2551
Practice Address - Fax:435-864-3573
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11650520-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist