Provider Demographics
NPI:1831164169
Name:GUNN, MATTHEW W (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:GUNN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 S ALLIANCE DR
Mailing Address - Street 2:STE 102A
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7172
Mailing Address - Country:US
Mailing Address - Phone:943-569-2303
Mailing Address - Fax:843-569-2304
Practice Address - Street 1:7 S ALLIANCE DR
Practice Address - Street 2:STE 102A
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7172
Practice Address - Country:US
Practice Address - Phone:943-569-2303
Practice Address - Fax:843-569-2304
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5161225100000X
PAPT015887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist