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Organization
GUNTER PHYSICAL THERAPY LLC
Active
Organization
GUNTER PHYSICAL THERAPY LLC
Active
Other names
SCOTT PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. RUSSELL WAYNE GUNTER DPT (OWNER)
(337) 504-2396
Entity
Organization
Contact information
Practice address
401 N COLLEGE RD, SUITE 1, LAFAYETTE, LA 70506-4263
(337) 504-2396
(337) 504-2884
Mailing address
PO BOX 61651, LAFAYETTE, LA 70596-1651
(337) 504-2396
(337) 504-2884
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4809
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5CQ69
MEDICARE PTAN
LA
Enumeration date
09/14/2011
Last updated
09/14/2011
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