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General NPI Number Information
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NPI Number | 1083271571
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Entity Type | Individual
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Provider Name | KELLI BLAIR GUNTER PT, DPT, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 2750 SW WILSHIRE BLVD
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City | BURLESON
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State | TX
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Zip | 76028-8338
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Country | US
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Telephone | 817-782-8050
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Fax | 817-782-8060
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Provider Business Mailing Address
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Address Line | 5150 CRENSHAW RD STE D100
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City | PASADENA
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State | TX
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Zip | 77505-3095
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Country | US
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Telephone | 713-943-1100
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Fax | 713-943-1178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5956
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1295352
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License Number State | TX
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