Provider Demographics
NPI:1780903161
Name:JUNGWIRTH, AMY FLORINDA (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:FLORINDA
Last Name:JUNGWIRTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:FLORINDA
Other - Last Name:JUNGWIRTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2326 CANYON LAKE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2913
Mailing Address - Country:US
Mailing Address - Phone:605-430-5388
Mailing Address - Fax:
Practice Address - Street 1:2326 CANYON LAKE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2913
Practice Address - Country:US
Practice Address - Phone:605-430-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD261172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist