Provider Demographics
NPI:1841509254
Name:MUNNELL, DAVID G (LMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MUNNELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OLD FORGE LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4132
Mailing Address - Country:US
Mailing Address - Phone:585-301-3894
Mailing Address - Fax:
Practice Address - Street 1:60 BARRETT DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2963
Practice Address - Country:US
Practice Address - Phone:585-872-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020620-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist