Provider Demographics
NPI:1184133159
Name:GUNN, ADAM (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:GUNN
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CRESTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5515
Mailing Address - Country:US
Mailing Address - Phone:479-216-2315
Mailing Address - Fax:479-413-8090
Practice Address - Street 1:300 CRESTWOOD CIR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5515
Practice Address - Country:US
Practice Address - Phone:479-216-2315
Practice Address - Fax:479-413-8090
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229816721Medicaid