Kendrick Justin King Gunning, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-4208 Issued in ID

Practice address

3330 E Louise Dr Ste 400
Meridian, ID 83642-5123

Phone

(208) 706-2333

NPI assigned

Jul 8, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1669034823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 E LOUISE DR STE 400",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 E LOUISE DR STE 400",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425123",
            "telephone_number": "208-706-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING GUNNING",
        "first_name": "KENDRICK",
        "middle_name": "JUSTIN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "PTA-4208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Meridian",
            "affiliation": "N",
            "address_1": "3330 E Louise Dr Ste 400",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836425123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Steven Killion, D.C.
• Susan C Kim, MD
• Stella Kimani
• Yvonne Kimazi
• Kimberly Ledwa, LLC
• Annastasia M King
• Carlyn King, D.O.
• Chandra Dawn King, FNP-C
• Dawn K King, M.D.
• Jacqueline King

• Physical Therapy Assistant in Meridian, ID
• Providers in Meridian, ID by specialty
• Physical Therapy Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.