Provider Demographics
NPI:1780133660
Name:MUNGER, KIEL
Entity type:Individual
Prefix:
First Name:KIEL
Middle Name:
Last Name:MUNGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 E BASELINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4418
Mailing Address - Country:US
Mailing Address - Phone:480-503-2373
Mailing Address - Fax:480-782-5213
Practice Address - Street 1:4210 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4418
Practice Address - Country:US
Practice Address - Phone:480-503-2373
Practice Address - Fax:480-782-5213
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist