Provider Demographics
NPI:1932608346
Name:KUNTZ, TIANA H (MAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:H
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 E BURLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2413
Mailing Address - Country:US
Mailing Address - Phone:559-707-8862
Mailing Address - Fax:
Practice Address - Street 1:651 E BURLWOOD LN
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2413
Practice Address - Country:US
Practice Address - Phone:559-707-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer