Provider Demographics
NPI:1437548468
Name:KUNZ, REBECCA (PT, DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KUNZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LISONBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1082 E MAIN ST APT 5
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4430
Mailing Address - Country:US
Mailing Address - Phone:951-675-0561
Mailing Address - Fax:
Practice Address - Street 1:366 E MESA VERDE LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1812
Practice Address - Country:US
Practice Address - Phone:702-227-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist