Provider Demographics
NPI:1790711190
Name:LUNT, KREGG TYLER (MSPT)
Entity Type:Individual
Prefix:MR
First Name:KREGG
Middle Name:TYLER
Last Name:LUNT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 NORTHFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9390
Mailing Address - Country:US
Mailing Address - Phone:435-865-1902
Mailing Address - Fax:435-586-5176
Practice Address - Street 1:1335 NORTHFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9390
Practice Address - Country:US
Practice Address - Phone:435-865-1902
Practice Address - Fax:435-586-5176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365460-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36546024000001OtherBLUE CROSS BLUE SHIELD TA
107009169101OtherSELECT HEALTH
36546024004001OtherBLUE CROSS BLUE SHIELD PP
7242295OtherAETNA
694369OtherDMBA
WA0183234OtherWASHINGTON STATE LABOR
64-00712OtherUNITED HEALTH CARE
64479OtherPEHP
PRA04973OtherMOLINA HEALTH CARE
WA0183234OtherWASHINGTON STATE LABOR