Healthcare Provider Details

I. General information

NPI: 1548266943
Provider Name (Legal Business Name): BRIAN BRUNKEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 'R' PLAZA STE 106
OMAHA NE
68135
US

IV. Provider business mailing address

11105 CROWN POINT AVE
OMAHA NE
68164-1509
US

V. Phone/Fax

Practice location:
  • Phone: 402-672-6945
  • Fax:
Mailing address:
  • Phone: 402-672-6945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1616
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1616
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: