Provider Demographics
NPI:1265072037
Name:GURNETT, DEVON (MSOM, ATC, LAT)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:GURNETT
Suffix:
Gender:M
Credentials:MSOM, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3655
Mailing Address - Country:US
Mailing Address - Phone:515-571-4280
Mailing Address - Fax:
Practice Address - Street 1:6007 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-3655
Practice Address - Country:US
Practice Address - Phone:515-571-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0011752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer