Provider Demographics
NPI:1083271571
Name:GUNTER, KELLI BLAIR (PT, DPT, ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:BLAIR
Last Name:GUNTER
Suffix:
Gender:F
Credentials:PT, DPT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 CRENSHAW RD STE D100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3095
Mailing Address - Country:US
Mailing Address - Phone:713-943-1100
Mailing Address - Fax:713-943-1178
Practice Address - Street 1:2750 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8338
Practice Address - Country:US
Practice Address - Phone:817-782-8050
Practice Address - Fax:817-782-8060
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59562255A2300X
TX12953522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer