Provider Demographics
NPI:1629386040
Name:GUNDY, PATRICIA KAY (CPTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY
Last Name:GUNDY
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 HOLLIDAY ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523-1137
Mailing Address - Country:US
Mailing Address - Phone:785-528-3301
Mailing Address - Fax:785-528-1124
Practice Address - Street 1:629 HOLLIDAY ST
Practice Address - Street 2:
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523-1137
Practice Address - Country:US
Practice Address - Phone:785-528-3301
Practice Address - Fax:785-528-1124
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1400652225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1932240678Medicaid
200431220AOtherKMAP GROUP #
KS205322594OtherGROUP TAX ID #
1235242460OtherGROUP NPI