Provider Demographics
NPI:1205118627
Name:KUNZ, TAMARA (DPT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:KUNZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:WIERINGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:8005 W FLORISSANT AVE STE L
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:MO
Practice Address - Zip Code:63136-1452
Practice Address - Country:US
Practice Address - Phone:314-833-1000
Practice Address - Fax:314-833-1001
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005780225200000X
MO2018045088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant