Provider Demographics
NPI:1841280419
Name:GUNLOCK, CORTNEE S (DPT)
Entity type:Individual
Prefix:
First Name:CORTNEE
Middle Name:S
Last Name:GUNLOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:PROF
Other - First Name:CORTNEE
Other - Middle Name:S
Other - Last Name:GUNLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:107 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-2634
Mailing Address - Country:US
Mailing Address - Phone:406-676-4441
Mailing Address - Fax:406-676-0835
Practice Address - Street 1:107 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2634
Practice Address - Country:US
Practice Address - Phone:406-676-4441
Practice Address - Fax:406-676-0835
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1800PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1841280419Medicaid
MTMSF1224957OtherMT STATE WORK COMP
MT0229573OtherWASHINGTON STATE DEPT OF LABOR & INDUSTRY
MT62088OtherBCBS OF MT PROVIDER #