Individual
KENNETH DAVID LUNDEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
13128 N 94TH DR STE 207, PEORIA, AZ 85381-4253
(623) 974-1797
(623) 974-1798
Mailing address
13128 N 94TH DR STE 207, PEORIA, AZ 85381-4253
(623) 974-1797
(623) 974-1798
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
683
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2293
HEALTH NET
AZ
01
—
650010309
RAILROAD MEDICARE
AZ
01
—
719065
AHCCCS
AZ
01
—
74518
BLUE CROSS BLUE SHIELD
AZ
01
—
860744695
UNITED HEALTHCARE
AZ
Enumeration date
02/28/2006
Last updated
06/08/2020
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