MEDICARE: SHARON MARIE KUNKEL PTA

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	225200000X	Physical Therapy Assistant	160000533	IL

General Provider Information

NPI Number	:	1417462821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MARIE KUNKEL PTA

Provider Business Mailing Address
First Line	:	5435 BULL VALLEY RD STE 110
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-2209
Country	:	US
Telephone Number	:	815-451-4502
Fax Number	:	815-977-8467

Provider Business Practice Location Address
First Line	:	5435 BULL VALLEY RD STE 110
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-2209
Country	:	US
Telephone Number	:	815-451-4502
Fax Number	:	815-977-8467

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

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “ SHARON MARIE KUNKEL PTA” Practice Location

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