Provider Demographics
NPI:1497231823
Name:GUNNELL, STEPHEN GARY (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GARY
Last Name:GUNNELL
Suffix:
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 1:1930 S ALMA SCHOOL RD STE A100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3065
Mailing Address - Country:US
Mailing Address - Phone:480-387-5429
Mailing Address - Fax:480-361-9562
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE A100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3065
Practice Address - Country:US
Practice Address - Phone:480-387-5429
Practice Address - Fax:480-361-9562
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZLPT-30134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist