Provider Demographics
NPI:1801927504
Name:GUNNER, KATHLEEN KLEKAMP (RPT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:KLEKAMP
Last Name:GUNNER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 WILDMARSH DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6571
Mailing Address - Country:US
Mailing Address - Phone:919-345-3411
Mailing Address - Fax:919-845-6224
Practice Address - Street 1:5241 WILDMARSH DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6571
Practice Address - Country:US
Practice Address - Phone:919-345-3411
Practice Address - Fax:919-845-6224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC067YTOtherBCBS
NC7211954Medicaid