Kristin Jolene Prunchak, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

4130 Northwest Blvd
Davenport, IA 52806-4243

Phone

(563) 388-3291

NPI assigned

Aug 1, 2019

Last updated

Aug 1, 2019By the provider in NPPES

Sex

Female

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 1

Other names 1

• Kristin Jolene Brimeyer Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1922652429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3399 SUNNY HILL DR",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527222316",
            "telephone_number": "563-343-8924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 NORTHWEST BLVD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528064243",
            "telephone_number": "563-388-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUNCHAK",
        "first_name": "KRISTIN",
        "middle_name": "JOLENE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-01",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE OBTAINED",
            "identifier": "NONE",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prunchakk@genesishealth.com",
            "affiliation": "N",
            "address_1": "4130 Northwest Blvd",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528064243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "BRIMEYER",
            "middle_name": "JOLENE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Madison Kay Purvis, MD
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• Physical Therapy Assistant in Davenport, IA
• Providers in Davenport, IA by specialty
• Physical Therapy Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; 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.