Provider Demographics
NPI:1699590356
Name:LUNDBERG, BRINDIS NICOLE (DPT, PT)
Entity type:Individual
Prefix:
First Name:BRINDIS
Middle Name:NICOLE
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12413 JUDSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3262
Mailing Address - Country:US
Mailing Address - Phone:210-656-7953
Mailing Address - Fax:210-656-7957
Practice Address - Street 1:7390 BARLITE BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1309
Practice Address - Country:US
Practice Address - Phone:210-534-7953
Practice Address - Fax:210-534-6695
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1402376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist