Provider Demographics
NPI:1033521794
Name:GAUNT, ANDREW
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GAUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8528 SILVER STRAND RD
Mailing Address - Street 2:
Mailing Address - City:LEVERING
Mailing Address - State:MI
Mailing Address - Zip Code:49755-9101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8528 SILVER STRAND RD
Practice Address - Street 2:
Practice Address - City:LEVERING
Practice Address - State:MI
Practice Address - Zip Code:49755-9101
Practice Address - Country:US
Practice Address - Phone:231-884-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1241158225100000X
FLPT26136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912340480OtherNPI