Healthcare Provider Details

I. General information

NPI: 1013691922
Provider Name (Legal Business Name): AMBER PEARL KUNZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 12TH ST SW STE 1
FOREST LAKE MN
55025-3780
US

IV. Provider business mailing address

280 12TH ST SW STE 1
FOREST LAKE MN
55025-3780
US

V. Phone/Fax

Practice location:
  • Phone: 612-751-4200
  • Fax:
Mailing address:
  • Phone: 612-751-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number25-0541
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: