Provider Demographics
NPI:1689054678
Name:LUNDY, BRACKON W (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRACKON
Middle Name:W
Last Name:LUNDY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W 94TH TER STE 112
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2534
Mailing Address - Country:US
Mailing Address - Phone:913-224-2990
Mailing Address - Fax:913-224-2992
Practice Address - Street 1:5200 W 94TH TER STE 112
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2534
Practice Address - Country:US
Practice Address - Phone:913-224-2990
Practice Address - Fax:913-224-2992
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020034225100000X
KS11-05068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist