Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070010574 | IL |
N | 2251S0007X | Physical Therapist - Sports | 070010574 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070010574 | IL |
NPI | 1144230582 |
---|---|
Provider Name | Mr. Earl Edward Gunther JR. |
First Address | Schaumburg, IL 60194-4065 |
Second Address | Schaumburg, IL 60194-4065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 20/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070010574 | PT LISCENCE NUMBER (01) | IL |
1634788 | BLUE CROSS GROUP NUMBER (01) | IL |
7739664 | AETNA PROVIDER ID (01) | IL |