Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1295352 | TX |
NPI | 1083271571 |
---|---|
Provider Name | Kelli Blair Gunter |
First Address | Pasadena, TX 77505-3095 |
Second Address | Pasadena, TX 77505-3095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |