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General NPI Number Information
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NPI Number | 1558337402
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Entity Type | Individual
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Provider Name | KENNETH DAVID LUNDEEN P.T.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 13128 N 94TH DR STE 207
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City | PEORIA
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State | AZ
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Zip | 85381-4253
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Country | US
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Telephone | 623-974-1797
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Fax | 623-974-1798
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Provider Business Mailing Address
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Address Line | 13128 N 94TH DR STE 207
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City | PEORIA
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State | AZ
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Zip | 85381-4253
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Country | US
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Telephone | 623-974-1797
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Fax | 623-974-1798
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 683
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License Number State | AZ
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