MEDICARE: LAURA E KUNKEL MS, LAT, ATC, PES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT4597	TX

General Provider Information

NPI Number	:	1174582241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA E KUNKEL MS, LAT, ATC, PES

Provider Business Mailing Address
First Line	:	8513 BONNET CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5319
Country	:	US
Telephone Number	:	817-471-4461
Fax Number	:

Provider Business Practice Location Address
First Line	:	8513 BONNET CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5319
Country	:	US
Telephone Number	:	817-471-4461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	09/09/2021

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