Healthcare Provider Details

I. General information

NPI: 1891776241
Provider Name (Legal Business Name): AMY L WUNSCH MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23206 LYONS AVE STE 105
SANTA CLARITA CA
91321
US

IV. Provider business mailing address

23206 LYONS AVE #105
SANTA CLARITA CA
91321-2822
US

V. Phone/Fax

Practice location:
  • Phone: 661-383-9828
  • Fax: 661-206-4153
Mailing address:
  • Phone: 661-383-9828
  • Fax: 661-206-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: