Provider Demographics
NPI:1205933124
Name:GUNN, SHARON (PT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:GUNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1765
Mailing Address - Country:US
Mailing Address - Phone:708-228-0509
Mailing Address - Fax:708-481-9529
Practice Address - Street 1:650 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1765
Practice Address - Country:US
Practice Address - Phone:708-228-0509
Practice Address - Fax:708-481-9529
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636381OtherBCBS