Provider Demographics
NPI:1508914201
Name:KUNKLER, MONICA (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:KUNKLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1704
Mailing Address - Country:US
Mailing Address - Phone:773-907-3599
Mailing Address - Fax:773-907-3510
Practice Address - Street 1:5414 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1704
Practice Address - Country:US
Practice Address - Phone:773-907-3599
Practice Address - Fax:773-907-3510
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623236OtherBCBS
IL1623236OtherBCBS
ILK16926Medicare UPIN