Provider Demographics
NPI:1346861036
Name:KUNKLE, SETH
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3530
Mailing Address - Country:US
Mailing Address - Phone:724-822-1608
Mailing Address - Fax:
Practice Address - Street 1:120 HOLLYWOOD DR STE 202
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7604
Practice Address - Country:US
Practice Address - Phone:724-287-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATSMG000956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty