Provider Demographics
NPI:1336419282
Name:PUNG, JOEL (RPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:PUNG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 TERRA CEIA BAY BLVD
Mailing Address - Street 2:# 1702
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5989
Mailing Address - Country:US
Mailing Address - Phone:941-447-7274
Mailing Address - Fax:
Practice Address - Street 1:2825 TERRA CEIA BAY BLVD
Practice Address - Street 2:# 1702
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5989
Practice Address - Country:US
Practice Address - Phone:941-447-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist