Provider Demographics
NPI:1568694602
Name:GUNVILLE, SARA MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:MARIE
Last Name:GUNVILLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 W WASHINGTON ST
Mailing Address - Street 2:STE 500
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4139
Mailing Address - Country:US
Mailing Address - Phone:906-225-5044
Mailing Address - Fax:906-225-5049
Practice Address - Street 1:1705 PYLE DR
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802-1143
Practice Address - Country:US
Practice Address - Phone:906-774-2900
Practice Address - Fax:906-774-2902
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014676OtherMICHIGAN LICENSE NUMBER
MI5501014676OtherMICHIGAN LICENSE NUMBER