MEDICARE: BRIAN BRUNKEN PT

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	1616	NE
2	2251X0800X	Orthopedic Physical Therapist	1616	NE

General Provider Information

NPI Number	:	1548266943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN BRUNKEN PT

Provider Business Mailing Address
First Line	:	11105 CROWN POINT AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-1509
Country	:	US
Telephone Number	:	402-672-6945
Fax Number	:

Provider Business Practice Location Address
First Line	:	18101 'R' PLAZA
Second Line	:	STE 106
City	:	OMAHA
State	:	NE
Zip	:	68135
Country	:	US
Telephone Number	:	402-672-6945
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/11/2025

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Directions to “ BRIAN BRUNKEN PT” Practice Location

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