Individual
TREVOR DALE MUNGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1700 E BOGARD RD STE 104, BUILDING B, WASILLA, AK 99654-6563
(907) 743-9991
(907) 743-9992
Mailing address
5701 LAKE OTIS PKWY STE 400, ANCHORAGE, AK 99507-1778
(907) 743-9991
(907) 743-9992
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO01700
DE
224L00000X
Pedorthist
CPO01700
DE
224P00000X
Prosthetist
CPO01700
DE
Other
Enumeration date
05/10/2012
Last updated
05/10/2012
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