Healthcare Provider Details

I. General information

NPI: 1821113960
Provider Name (Legal Business Name): JESSEE GUNN PT,MS,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 UNIVERSITY SHOPPING CTR
RICHMOND KY
40475-2614
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-5684
  • Fax: 859-624-0003
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004603
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: