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NPI Code Detail

MEDICARE: LANCE E GUNNING MS, ATC, LAT, LPTA

MEDICARE:   LANCE E GUNNING  MS, ATC, LAT, LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA18764FL
22255A2300XAthletic TrainerAL62FL

General Provider Information

NPI Number : 1710490644
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANCE E GUNNING MS, ATC, LAT, LPTA
Provider Business Mailing Address
First Line : 7410 SALE BLVD
Second Line :
City : SOUTHPORT
State : FL
Zip : 32409-1350
Country : US
Telephone Number : 850-271-4371
Fax Number :
Provider Business Practice Location Address
First Line : 1827 HARRISON AVE UNIT 4
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-7606
Country : US
Telephone Number : 850-872-7022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2017
Last Update Date : 11/14/2017

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Directions to “ LANCE E GUNNING MS, ATC, LAT, LPTA” Practice Location

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