Provider Demographics
NPI:1134324924
Name:NUNN, ROBERT CARL (LPTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:NUNN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 FAIRMONT CIR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1808
Mailing Address - Country:US
Mailing Address - Phone:903-654-5619
Mailing Address - Fax:
Practice Address - Street 1:150 GIBSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-677-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2061249225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant