Provider Demographics
NPI:1912688201
Name:FLATT-KUNTZE, JUSTIN GREGORY (LMT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:GREGORY
Last Name:FLATT-KUNTZE
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 1:263 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1225
Mailing Address - Country:US
Mailing Address - Phone:630-270-4809
Mailing Address - Fax:
Practice Address - Street 1:263 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1225
Practice Address - Country:US
Practice Address - Phone:630-270-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist