Provider Demographics
NPI:1306157268
Name:BUNGER, ALAN C (PT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:BUNGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-7470
Mailing Address - Country:US
Mailing Address - Phone:423-788-4636
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST STE 425
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7587
Practice Address - Country:US
Practice Address - Phone:423-788-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518416Medicaid
TN6072349OtherBLUE CROSS BLUE SHIELD TN