MEDICARE: DUSTIN KUNZ

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	225100000X	Physical Therapist	11650520-2401	UT

General Provider Information

NPI Number	:	1235779224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN KUNZ

Provider Business Mailing Address
First Line	:	95 WHITE SAGE AVE STE C
Second Line	:
City	:	DELTA
State	:	UT
Zip	:	84624-5555
Country	:	US
Telephone Number	:	435-864-2551
Fax Number	:	435-864-3573

Provider Business Practice Location Address
First Line	:	95 WHITE SAGE AVE STE C
Second Line	:
City	:	DELTA
State	:	UT
Zip	:	84624-5555
Country	:	US
Telephone Number	:	435-864-2551
Fax Number	:	435-864-3573

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	03/04/2020

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Directions to “ DUSTIN KUNZ ” Practice Location

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