Provider Demographics
NPI:1891776241
Name:WUNSCH, AMY L (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:WUNSCH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23206 LYONS AVE
Mailing Address - Street 2:#105
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2822
Mailing Address - Country:US
Mailing Address - Phone:613-839-8286
Mailing Address - Fax:661-206-4153
Practice Address - Street 1:23206 LYONS AVE STE 105
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-383-9828
Practice Address - Fax:661-206-4153
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT29208CMedicare ID - Type Unspecified
WPT29208AMedicare ID - Type Unspecified