Provider Demographics
NPI:1659577781
Name:GUMM, JOSEPH CHAD (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHAD
Last Name:GUMM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1143
Mailing Address - Country:US
Mailing Address - Phone:314-560-7595
Mailing Address - Fax:
Practice Address - Street 1:105 S 6TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1328
Practice Address - Country:US
Practice Address - Phone:636-257-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002029173225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant