MEDICARE: MRS. ALYDA CATHERINE KUNTZ P.T.

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	36245	CA

General Provider Information

NPI Number	:	1457689457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYDA CATHERINE KUNTZ P.T.

Provider Business Mailing Address
First Line	:	6695 E PACIFIC COAST HWY STE 100
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4256
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

Provider Business Practice Location Address
First Line	:	6695 E PACIFIC COAST HWY STE 100
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4256
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

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

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	10/05/2012

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