Provider Demographics
NPI:1154347763
Name:GUNN, ANDREA R (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:GUNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:RASNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:440 UNIT D OLD TROLLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485
Mailing Address - Country:US
Mailing Address - Phone:843-871-3522
Mailing Address - Fax:843-871-3523
Practice Address - Street 1:2695 ELMS PLANTATION BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7132
Practice Address - Country:US
Practice Address - Phone:843-974-4097
Practice Address - Fax:843-974-4125
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist