Provider Demographics
NPI:1437245917
Name:GUNTER, BRADLEY SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:GUNTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 N. MERIDIAN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290
Mailing Address - Country:US
Mailing Address - Phone:317-575-2100
Mailing Address - Fax:317-575-2105
Practice Address - Street 1:10601 N. MERIDIAN ST., SUITE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290
Practice Address - Country:US
Practice Address - Phone:317-575-2100
Practice Address - Fax:317-575-2105
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003347A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN156547Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER