Provider Demographics
NPI:1194924746
Name:LUNDBLAD, MICHAEL GREGORY (PT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GREGORY
Last Name:LUNDBLAD
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 1:9221 WADSWORTH PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4598
Mailing Address - Country:US
Mailing Address - Phone:303-403-2933
Mailing Address - Fax:303-403-2998
Practice Address - Street 1:1204 LOMBARDI ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6956
Practice Address - Country:US
Practice Address - Phone:720-384-8418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist