Provider Demographics
NPI:1740231901
Name:KUNZWEILER, JACQUELINE (RPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KUNZWEILER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:KUNZWEILER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:3401 W 49TH ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2322
Mailing Address - Country:US
Mailing Address - Phone:605-328-1649
Mailing Address - Fax:605-328-1640
Practice Address - Street 1:3401 W 49TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2322
Practice Address - Country:US
Practice Address - Phone:605-328-1649
Practice Address - Fax:605-328-1640
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00445320Medicare PIN
NE281867Medicare PIN