Active NPI
Lane Gunnell
- Physical Therapy Assistant
- Alamogordo, NM
National Provider Identifier
1356600191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 6695122-2402
- Practice address
- 205 Moonglow Ave
Alamogordo, NM 88310-3339 - Phone
- (575) 434-4510
- NPI assigned
- May 14, 2012
- Last updated
- May 14, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 6695122-2402 | UT | Primary |
Addresses
Primary practice location
205 Moonglow Ave
Alamogordo, NM 88310-3339
Mailing address
5000 Birch St
3000 West Tower
Newport Beach, CA 92660-2127
Phone (888) 835-0894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6695122-2402 | UT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336953600000",
"number": "1356600191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 BIRCH ST",
"address_2": "3000 WEST TOWER",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926602127",
"telephone_number": "888-835-0894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 MOONGLOW AVE",
"city": "ALAMOGORDO",
"state": "NM",
"postal_code": "883103339",
"telephone_number": "575-434-4510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNNELL",
"first_name": "LANE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-14",
"last_updated": "2012-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "UT",
"license": "6695122-2402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alamogordo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.