MEDICARE: JAMES WUNDRAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	008626	KY

General Provider Information

NPI Number	:	1538034707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WUNDRAK

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	726-202-3039
Fax Number	:	210-978-5592

Provider Business Practice Location Address
First Line	:	127 CLAY DR
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1349
Country	:	US
Telephone Number	:	859-756-3281
Fax Number	:	859-756-3640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/08/2025

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Directions to “ JAMES WUNDRAK ” Practice Location

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