Provider Demographics
NPI:1821113960
Name:GUNN, JESSEE (PT,MS,DPT)
Entity Type:Individual
Prefix:
First Name:JESSEE
Middle Name:
Last Name:GUNN
Suffix:
Gender:F
Credentials:PT,MS,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5733
Practice Address - Street 1:644 UNIVERSITY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2614
Practice Address - Country:US
Practice Address - Phone:859-624-5684
Practice Address - Fax:859-624-0003
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0633412Medicare PIN