Provider Demographics
NPI:1881090017
Name:BUNCH, KEITH MORGAN (MED, ATC, LAT, CES)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:MORGAN
Last Name:BUNCH
Suffix:
Gender:M
Credentials:MED, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MTSU SPORTS MEDICINE
Mailing Address - Street 2:1500 GREENLAND DRIVE
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37132-0001
Mailing Address - Country:US
Mailing Address - Phone:615-904-8302
Mailing Address - Fax:615-904-8301
Practice Address - Street 1:MTSU SPORTS MEDICINE
Practice Address - Street 2:1500 GREENLAND DRIVE
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37132-0001
Practice Address - Country:US
Practice Address - Phone:615-904-8302
Practice Address - Fax:615-904-8301
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT00000018832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer