Provider Demographics
NPI:1144230582
Name:GUNTHER, EARL EDWARD JR (PT)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:EDWARD
Last Name:GUNTHER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W SCHAUMBURG RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4065
Mailing Address - Country:US
Mailing Address - Phone:847-895-2910
Mailing Address - Fax:847-895-2911
Practice Address - Street 1:1443 W SCHAUMBURG RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-4065
Practice Address - Country:US
Practice Address - Phone:847-895-2910
Practice Address - Fax:847-895-2911
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010574225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634788OtherBLUE CROSS GROUP NUMBER
IL7739664OtherAETNA PROVIDER ID
IL070010574OtherPT LISCENCE NUMBER
ILK14167Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
IL210813Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER