Provider Demographics
NPI:1457689457
Name:KUNTZ, ALYDA CATHERINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALYDA
Middle Name:CATHERINE
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYDA
Other - Middle Name:CATHERINE
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6695 E PACIFIC COAST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4256
Mailing Address - Country:US
Mailing Address - Phone:562-596-7074
Mailing Address - Fax:562-596-7214
Practice Address - Street 1:6695 E PACIFIC COAST HWY STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4256
Practice Address - Country:US
Practice Address - Phone:562-596-7074
Practice Address - Fax:562-596-7214
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist