Provider Demographics
NPI:1104901743
Name:LUNDEEN, STEVEN BRETT (PT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRETT
Last Name:LUNDEEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 N ARROYO LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2943
Mailing Address - Country:US
Mailing Address - Phone:480-287-3828
Mailing Address - Fax:
Practice Address - Street 1:1079 N ARROYO LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2943
Practice Address - Country:US
Practice Address - Phone:480-287-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ579849Medicaid