Provider Demographics
NPI:1568053064
Name:GUNN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 SW 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5409
Mailing Address - Country:US
Mailing Address - Phone:405-759-2700
Mailing Address - Fax:405-759-2722
Practice Address - Street 1:526 SW 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5409
Practice Address - Country:US
Practice Address - Phone:405-759-2700
Practice Address - Fax:405-759-2722
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2379225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant