Kenneth David Lundeen, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

683 Issued in AZ

Practice address

13128 N 94TH Dr Ste 207
Peoria, AZ 85381-4253

Phone

(623) 974-1797

Fax

(623) 974-1798

NPI assigned

Feb 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Rehabilitation of Sun City

  • Physical Medicine & Rehabilitation Physician
  • Sun City West, AZ
  • NPI 1942728340

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1558337402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13128 N 94TH DR STE 207",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814253",
            "telephone_number": "623-974-1797",
            "fax_number": "623-974-1798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13128 N 94TH DR STE 207",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814253",
            "telephone_number": "623-974-1797",
            "fax_number": "623-974-1798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13460 N 94th Dr",
            "address_2": "G-1",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853814835",
            "country_code": "US",
            "telephone_number": "623-974-1797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUNDEEN",
        "first_name": "KENNETH",
        "middle_name": "DAVID",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2Z2293",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "74518",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "860744695",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650010309",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "719065",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.