Provider Demographics
NPI:1144396359
Name:GUNNARSSON, GUNDI HEIMIR (PT)
Entity Type:Individual
Prefix:
First Name:GUNDI
Middle Name:HEIMIR
Last Name:GUNNARSSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:GUDMUNDUR
Other - Middle Name:HEIMIR
Other - Last Name:GUNNARSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1845 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3467
Mailing Address - Country:US
Mailing Address - Phone:909-890-9030
Mailing Address - Fax:909-890-4393
Practice Address - Street 1:1845 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3467
Practice Address - Country:US
Practice Address - Phone:909-890-9030
Practice Address - Fax:909-890-4393
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH578UMedicare PIN
CABH578ZMedicare PIN
CACA142278Medicare PIN