Healthcare Provider Details

I. General information

NPI: 1730972001
Provider Name (Legal Business Name): KRISTEN GUNN DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN HOLCER

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 VETERANS MEMORIAL DR
CAPE GIRARDEAU MO
63701-9620
US

IV. Provider business mailing address

27664 HIGHWAY 139
MEADVILLE MO
64659-8443
US

V. Phone/Fax

Practice location:
  • Phone: 573-290-5870
  • Fax:
Mailing address:
  • Phone: 660-349-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2014026962
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2014029943
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: