Provider Demographics
NPI:1891310108
Name:KUNZ, NICOLE (LMT, CNMT, TYMP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KUNZ
Suffix:
Gender:F
Credentials:LMT, CNMT, TYMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MESA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3119
Mailing Address - Country:US
Mailing Address - Phone:719-237-3321
Mailing Address - Fax:
Practice Address - Street 1:1912 W UINTAH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2740
Practice Address - Country:US
Practice Address - Phone:719-237-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist