Provider Demographics
NPI:1588816847
Name:GUNTER, ELLIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:
Last Name:GUNTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:STAFFORD-GUNTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8737 112TH WAY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3642
Mailing Address - Country:US
Mailing Address - Phone:727-393-2226
Mailing Address - Fax:727-393-2226
Practice Address - Street 1:5141 SEMINOLE BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3365
Practice Address - Country:US
Practice Address - Phone:727-393-2226
Practice Address - Fax:727-393-2226
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0005108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist