Provider Demographics
NPI:1609767151
Name:GUNDERSEN, SETH RYAN
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:RYAN
Last Name:GUNDERSEN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4464
Mailing Address - Country:US
Mailing Address - Phone:361-774-8556
Mailing Address - Fax:
Practice Address - Street 1:4534 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4464
Practice Address - Country:US
Practice Address - Phone:361-774-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer