Healthcare Provider Details

I. General information

NPI: 1689785438
Provider Name (Legal Business Name): GARY WILLIAM MUNSTER RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 WOODLEY AVE STE 107
GRANADA HILLS CA
91344-6900
US

IV. Provider business mailing address

10315 WOODLEY AVE STE 107
GRANADA HILLS CA
91344-6900
US

V. Phone/Fax

Practice location:
  • Phone: 818-368-5906
  • Fax: 818-368-5906
Mailing address:
  • Phone: 818-368-5906
  • Fax: 818-368-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT8582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: