Provider Demographics
NPI:1295794899
Name:KUNTZ, AMANDA R (MS, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 COUNTRY DR
Mailing Address - Street 2:APT. 302
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3181
Mailing Address - Country:US
Mailing Address - Phone:847-715-8703
Mailing Address - Fax:
Practice Address - Street 1:1903 COUNTRY DR
Practice Address - Street 2:APT. 302
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3181
Practice Address - Country:US
Practice Address - Phone:847-715-8703
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer