Provider Demographics
NPI:1922897974
Name:KUNZE, MADELINE CAMILLE (LMT)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:CAMILLE
Last Name:KUNZE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 W VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHIMACUM
Mailing Address - State:WA
Mailing Address - Zip Code:98325-9751
Mailing Address - Country:US
Mailing Address - Phone:360-670-7682
Mailing Address - Fax:
Practice Address - Street 1:91 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-5101
Practice Address - Country:US
Practice Address - Phone:360-437-3798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61587320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist