Healthcare Provider Details

I. General information

NPI: 1841280419
Provider Name (Legal Business Name): CORTNEE S GUNLOCK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PROF. CORTNEE S GUNLOCK

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 6TH AVE SW
RONAN MT
59864-2634
US

IV. Provider business mailing address

107 6TH AVE SW
RONAN MT
59864-2634
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-4441
  • Fax: 406-676-0835
Mailing address:
  • Phone: 406-676-4441
  • Fax: 406-676-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1800PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: