Provider Demographics
NPI:1902867724
Name:BRUNDAGE, ANTHONY J (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BRUNDAGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GATEWAY CORNERS PARK
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8906
Mailing Address - Country:US
Mailing Address - Phone:803-359-2323
Mailing Address - Fax:803-359-2331
Practice Address - Street 1:608 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATESBURG-LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7318
Practice Address - Country:US
Practice Address - Phone:803-359-2323
Practice Address - Fax:803-359-2331
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist