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NPI Code Detail

MEDICARE: JENNIFER KUNBERGER PT

MEDICARE: JENNIFER KUNBERGER PT
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
1225100000XPhysical Therapist05009245AIN

General Provider Information

NPI Number : 1568667871
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER KUNBERGER PT
Provider Business Mailing Address
First Line : 5500 S SHORE DR
Second Line : APT 107
City : CHICAGO
State : IL
Zip : 60637-1965
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3840 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1708
Country : US
Telephone Number : 260-483-2422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 07/08/2007

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