Provider Demographics
NPI:1245331560
Name:LUNDGAARD, JOSH E (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JOSH
Middle Name:E
Last Name:LUNDGAARD
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BRICKYARD POINT RD S
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1206
Mailing Address - Country:US
Mailing Address - Phone:843-228-4485
Mailing Address - Fax:
Practice Address - Street 1:1ST RECRUIT TRAINING BATTALION HQ, USMCRD-PI
Practice Address - Street 2:BUILDING 592, RM 133
Practice Address - City:PARRIS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer