Provider Demographics
NPI:1689252462
Name:BRUNER, KYNDAHL MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:KYNDAHL
Middle Name:MARIE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KYNDAHL
Other - Middle Name:MARIE
Other - Last Name:ULMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1188 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3009
Mailing Address - Country:US
Mailing Address - Phone:208-395-8264
Mailing Address - Fax:208-345-9514
Practice Address - Street 1:1188 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3009
Practice Address - Country:US
Practice Address - Phone:208-395-8264
Practice Address - Fax:208-345-9514
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist