Provider Demographics
NPI:1174507727
Name:KUNDE, FREDERICK JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:JAMES
Last Name:KUNDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 JACKSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2921
Mailing Address - Country:US
Mailing Address - Phone:940-723-3117
Mailing Address - Fax:940-723-3140
Practice Address - Street 1:4601 JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2921
Practice Address - Country:US
Practice Address - Phone:940-723-3117
Practice Address - Fax:940-723-3140
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304223YNDPMedicare PIN
TX1040527OtherBLUE LINK #
TX125089OtherSUPERIOR PROVIDER #
TX8T2848OtherBCBS PROVIDER #