Healthcare Provider Details

I. General information

NPI: 1831761683
Provider Name (Legal Business Name): BRYAN I SUNDY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD
BOISE ID
83706-1338
US

IV. Provider business mailing address

6210 W DOUGLAS ST APT 201
BOISE ID
83704-9447
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3315
  • Fax:
Mailing address:
  • Phone: 716-803-4086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7038
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: