Provider Demographics
NPI:1114409539
Name:BLUNTZER, KIERSTEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:ELIZABETH
Last Name:BLUNTZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 ELMONT DR APT 116
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1715
Mailing Address - Country:US
Mailing Address - Phone:361-877-3663
Mailing Address - Fax:
Practice Address - Street 1:4600 ELMONT DR APT 116
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1715
Practice Address - Country:US
Practice Address - Phone:361-877-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer