MEDICARE: ANDREA R GUNN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3858	SC

General Provider Information

NPI Number	:	1154347763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA R GUNN P.T.

Provider Business Mailing Address
First Line	:	440 UNIT D OLD TROLLEY ROAD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485
Country	:	US
Telephone Number	:	843-871-3522
Fax Number	:	843-871-3523

Provider Business Practice Location Address
First Line	:	2695 ELMS PLANTATION BLVD STE C
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-7132
Country	:	US
Telephone Number	:	843-974-4097
Fax Number	:	843-974-4125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/07/2019

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