Provider Demographics
NPI:1356759179
Name:BUNT, STEPHEN (L/ATC EDD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:BUNT
Suffix:
Gender:M
Credentials:L/ATC EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CREST RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-9337
Mailing Address - Country:US
Mailing Address - Phone:469-371-1733
Mailing Address - Fax:
Practice Address - Street 1:502 CREST RIDGE CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-9337
Practice Address - Country:US
Practice Address - Phone:469-371-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT04031744R1102X
TXAT 04032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No1744R1102XOther Service ProvidersSpecialistResearch Study