Provider Demographics
NPI:1790072502
Name:KUNTZ, JAMIE REBECCA (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:REBECCA
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 WARBLER WAY UNIT 5
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7743
Mailing Address - Country:US
Mailing Address - Phone:406-595-1707
Mailing Address - Fax:
Practice Address - Street 1:1087 STONERIDGE DR APT 2A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7057
Practice Address - Country:US
Practice Address - Phone:406-595-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist