Provider Demographics
NPI:1457326118
Name:LUNGSTRUM, ANTHONY JOSEPH (ATC, LAT, OTC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:LUNGSTRUM
Suffix:
Gender:M
Credentials:ATC, LAT, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 DOWNING CT
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-7711
Mailing Address - Country:US
Mailing Address - Phone:573-884-2071
Mailing Address - Fax:573-882-0569
Practice Address - Street 1:1 S KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7199
Practice Address - Country:US
Practice Address - Phone:573-443-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200700169002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer