Provider Demographics
NPI:1942484134
Name:KUNKLER, MELANIE (PT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KUNKLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:BRODSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:101 EXECUTIVE DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4236
Mailing Address - Country:US
Mailing Address - Phone:609-707-8613
Mailing Address - Fax:
Practice Address - Street 1:101 EXECUTIVE DR
Practice Address - Street 2:SUITE 9
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-4236
Practice Address - Country:US
Practice Address - Phone:609-707-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00774600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066665PCVMedicare PIN