Provider Demographics
NPI:1255328258
Name:BRUNEN, KERRI (PT)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:BRUNEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13318 FOXFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:972-486-3115
Practice Address - Street 1:13401 CHENAL PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5383
Practice Address - Country:US
Practice Address - Phone:501-821-6934
Practice Address - Fax:214-265-7521
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83292EMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER