Provider Demographics
NPI:1689453383
Name:BRUNICK, KAYLEE CHRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:CHRISTINE
Last Name:BRUNICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5621
Mailing Address - Country:US
Mailing Address - Phone:605-782-9436
Mailing Address - Fax:
Practice Address - Street 1:2101 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5621
Practice Address - Country:US
Practice Address - Phone:605-782-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation