Provider Demographics
NPI:1225346760
Name:BRUNKOW, AMANDA ANNETTE
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ANNETTE
Last Name:BRUNKOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SW 6TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1582
Mailing Address - Country:US
Mailing Address - Phone:785-233-5500
Mailing Address - Fax:785-233-5512
Practice Address - Street 1:1315 SW 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1581
Practice Address - Country:US
Practice Address - Phone:785-233-5500
Practice Address - Fax:785-233-5512
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant