Provider Demographics
NPI:1164747283
Name:BRUNK, ANDREA RIBANDO (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RIBANDO
Last Name:BRUNK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1638
Mailing Address - Country:US
Mailing Address - Phone:617-733-8590
Mailing Address - Fax:
Practice Address - Street 1:3709 3RD ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1638
Practice Address - Country:US
Practice Address - Phone:617-733-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT8705492251P0200X
VA23052044192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics