Provider Demographics
NPI:1902542301
Name:MUNCH, CORAL RAE (DPT)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:RAE
Last Name:MUNCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:RAE
Other - Last Name:KNERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 WARNER DR STE 8
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4441
Mailing Address - Country:US
Mailing Address - Phone:208-746-7573
Mailing Address - Fax:
Practice Address - Street 1:328 WARNER DR STE 8
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4441
Practice Address - Country:US
Practice Address - Phone:208-746-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist