Provider Demographics
NPI:1689785438
Name:MUNSTER, GARY WILLIAM (RPT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WILLIAM
Last Name:MUNSTER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 WOODLEY AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6900
Mailing Address - Country:US
Mailing Address - Phone:818-368-5906
Mailing Address - Fax:818-368-5906
Practice Address - Street 1:10315 WOODLEY AVE STE 107
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6900
Practice Address - Country:US
Practice Address - Phone:818-368-5906
Practice Address - Fax:818-368-5906
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT85822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics