Provider Demographics
NPI:1700064748
Name:LUNDY, DANIEL EDWARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EDWARD
Last Name:LUNDY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 EDEN TER
Mailing Address - Street 2:WINTHROP COLISEUM
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3208
Mailing Address - Country:US
Mailing Address - Phone:803-323-2129
Mailing Address - Fax:
Practice Address - Street 1:1162 EDEN TER
Practice Address - Street 2:WINTHROP COLISEUM
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3208
Practice Address - Country:US
Practice Address - Phone:803-323-2129
Practice Address - Fax:803-323-3933
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer