Provider Demographics
NPI:1518633270
Name:BUNSELMEYER, KOURTNEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KOURTNEY
Middle Name:
Last Name:BUNSELMEYER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 LOVE DR APT 1061
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4092
Mailing Address - Country:US
Mailing Address - Phone:618-534-2779
Mailing Address - Fax:
Practice Address - Street 1:1215 KINWEST PKWY UNIT 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3403
Practice Address - Country:US
Practice Address - Phone:972-506-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist