Individual
KRISTIN JOLENE PRUNCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4130 NORTHWEST BLVD, DAVENPORT, IA 52806-4243
(563) 388-3291
Mailing address
3399 SUNNY HILL DR, BETTENDORF, IA 52722-2316
(563) 343-8924
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE OBTAINED
IA
Enumeration date
08/01/2019
Last updated
08/01/2019
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