Healthcare Provider Details

I. General information

NPI: 1174143424
Provider Name (Legal Business Name): KYLE SHUNK RRT, RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

207 N OAK ST
LONDON OH
43140-1021
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8333
  • Fax:
Mailing address:
  • Phone: 740-506-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP.14866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: