Provider Demographics
NPI:1356035273
Name:LUNNEY, CALEB EDWARD (ATC, LAT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:EDWARD
Last Name:LUNNEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 MAIN ST APT 15
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1340
Mailing Address - Country:US
Mailing Address - Phone:913-749-6650
Mailing Address - Fax:
Practice Address - Street 1:201 TRUEBLOOD AVE
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-1757
Practice Address - Country:US
Practice Address - Phone:800-779-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1206132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer