Provider Demographics
NPI:1467530865
Name:KUNKEL, STEVEN CRAIG JR (PT, OCS, COMT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CRAIG
Last Name:KUNKEL
Suffix:JR
Gender:M
Credentials:PT, OCS, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 SOUTH BRIDGE STREET PLAZA
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-8707
Practice Address - Country:US
Practice Address - Phone:410-392-0800
Practice Address - Fax:410-392-0815
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD197094ZBL8Medicare PIN