Provider Demographics
NPI:1518024256
Name:KUNICH, BRIAN MITCHELL (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MITCHELL
Last Name:KUNICH
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 1:18015 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7612
Mailing Address - Country:US
Mailing Address - Phone:602-388-4236
Mailing Address - Fax:
Practice Address - Street 1:825 E WARNER RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-0994
Practice Address - Country:US
Practice Address - Phone:480-722-0300
Practice Address - Fax:480-722-0302
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER