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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