Provider Demographics
NPI:1275512246
Name:GUNTER, GLORIA GOULD (MPT, MED, PCS)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:GOULD
Last Name:GUNTER
Suffix:
Gender:F
Credentials:MPT, MED, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-0092
Mailing Address - Country:US
Mailing Address - Phone:208-720-3421
Mailing Address - Fax:208-297-2680
Practice Address - Street 1:113 E BULLION ST
Practice Address - Street 2:SUITE C
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8770
Practice Address - Country:US
Practice Address - Phone:208-720-3421
Practice Address - Fax:208-297-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT1204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T4868OtherBLUE CROSS OF IDAHO
000010030447OtherBLUE SHIELD OF IDAHO
ID1275512246Medicaid
000010030447OtherBLUE SHIELD OF IDAHO