Provider Demographics
NPI:1184968463
Name:KUNTZMAN, CAROLE LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:LYNN
Last Name:KUNTZMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-9602
Mailing Address - Country:US
Mailing Address - Phone:419-253-7064
Mailing Address - Fax:
Practice Address - Street 1:4469 COUNTY ROAD 213
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-9602
Practice Address - Country:US
Practice Address - Phone:419-253-7064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07773225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant