Provider Demographics
NPI:1609240019
Name:LUNN, GRETCHEN (PTA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:LUNN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 OTAY LAKES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-8904
Mailing Address - Country:US
Mailing Address - Phone:619-421-0444
Mailing Address - Fax:
Practice Address - Street 1:690 OTAY LAKES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-8904
Practice Address - Country:US
Practice Address - Phone:619-421-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11164225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant