Adam Gunn, PT, DPT, OCS
Individual provider Active NPI Physical Therapist · Mena, AR
NPI 1184133159 · NPPES record last updated Nov 30, 2024
Key facts
- NPI
- 1184133159
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 4371 (AR)
- Practice address
- 300 Crestwood Cir
Mena, AR 71953-5515 - Phone
- (479) 216-2315
- Fax
- (479) 413-8090
- NPI assigned
- Sep 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advanced Spine and Therapy, LLC
Practice addresses (Care Compare)
1311B Hwy 71 N
Mena, AR 71953-8447
Phone (479) 216-2315
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180807000879 | AR | Practitioner - Physical Therapist in Private Practice | 9638427743 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4371 | AR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Spine & Therapy, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
1311B Highway 71 N
Mena, AR 71953
Phone (479) 216-2315
300 Crestwood Cir
Mena, AR 71953
Phone (479) 394-1600
1311 Highway 71 N
#B
Mena, AR 71953
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4371 | AR | Yes |
Addresses
Primary practice location
300 Crestwood Cir
Mena, AR 71953-5515
Mailing address
300 Crestwood Cir
Mena, AR 71953-5515
Phone (479) 216-2315
Other practice location 1
354 Polk Road 48
Mena, AR 71953-3874
Phone (479) 216-2315
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 229816721 | Medicaid | AR |
Other providers in Mena, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.