Provider Demographics
NPI:1821118928
Name:MUNDERLOH, AARON ARNOLD (PT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:ARNOLD
Last Name:MUNDERLOH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-9768
Mailing Address - Country:US
Mailing Address - Phone:989-717-1419
Mailing Address - Fax:
Practice Address - Street 1:7338 N ALGER RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1072
Practice Address - Country:US
Practice Address - Phone:989-463-0345
Practice Address - Fax:989-466-5472
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650B910460OtherBCBS
MIOP28950Medicare ID - Type UnspecifiedMEDICARE GROUP