Provider Demographics
NPI:1710490644
Name:GUNNING, LANCE E (MS, ATC, LAT, LPTA)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:E
Last Name:GUNNING
Suffix:
Gender:M
Credentials:MS, ATC, LAT, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 SALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32409-1350
Mailing Address - Country:US
Mailing Address - Phone:850-271-4371
Mailing Address - Fax:
Practice Address - Street 1:1827 HARRISON AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7606
Practice Address - Country:US
Practice Address - Phone:850-872-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18764225200000X
FLAL622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant