Provider Demographics
NPI:1609660893
Name:JOEDPT123
Entity type:Organization
Organization Name:JOEDPT123
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KUNDRAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-649-9160
Mailing Address - Street 1:3183 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7565
Mailing Address - Country:US
Mailing Address - Phone:734-649-9160
Mailing Address - Fax:
Practice Address - Street 1:148 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1820
Practice Address - Country:US
Practice Address - Phone:734-649-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy