Provider Demographics
NPI:1588796924
Name:KUNTZ, LEE DAVID (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:DAVID
Last Name:KUNTZ
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 26TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2240
Mailing Address - Country:US
Mailing Address - Phone:330-456-0612
Mailing Address - Fax:330-456-7947
Practice Address - Street 1:2400 EAST CAPITOL ST SE
Practice Address - Street 2:RFK STADIUM, GATE F
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-731-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0005702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART000156AOtherLICENSE NUMBER
OHAT.000570OtherLICENSE NUMBER