Provider Demographics
NPI:1184701781
Name:KUNKEL, KEVIN ROBERT (MSPT,MLD-CDT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROBERT
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:MSPT,MLD-CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 GOLF RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-5509
Mailing Address - Country:US
Mailing Address - Phone:561-436-3273
Mailing Address - Fax:772-878-6546
Practice Address - Street 1:311 GOLF RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5509
Practice Address - Country:US
Practice Address - Phone:561-436-3273
Practice Address - Fax:772-878-6546
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLY4111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4111Medicare ID - Type UnspecifiedPHYSICAL THERAPY