Provider Demographics
NPI:1164461687
Name:TUNBERG, PATRICIA MARY (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:TUNBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:NOWLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1545 W US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1562
Mailing Address - Country:US
Mailing Address - Phone:219-836-5381
Mailing Address - Fax:219-836-4466
Practice Address - Street 1:1545 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1562
Practice Address - Country:US
Practice Address - Phone:219-836-5381
Practice Address - Fax:219-836-4466
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001565A225100000X
IL070004387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist