Provider Demographics
NPI:1679941249
Name:KUNKLE, RYAN (ATC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 FAIRLAND DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2879
Mailing Address - Country:US
Mailing Address - Phone:610-349-1477
Mailing Address - Fax:
Practice Address - Street 1:3314 FAIRLAND DR
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2879
Practice Address - Country:US
Practice Address - Phone:610-349-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer