Healthcare Provider Details

I. General information

NPI: 1700479789
Provider Name (Legal Business Name): ANTOINETTE GUNTHNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 RUNNYMEDE LN
CHARLOTTE NC
28209-3316
US

IV. Provider business mailing address

6005 SENTINEL DR
INDIAN TRAIL NC
28079-3417
US

V. Phone/Fax

Practice location:
  • Phone: 704-525-5508
  • Fax: 704-527-7027
Mailing address:
  • Phone: 704-241-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9023
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: