Provider Demographics
NPI:1710214580
Name:GUMTANG, JOANNA MARIE (RPT)
Entity Type:Individual
Prefix:MISS
First Name:JOANNA MARIE
Middle Name:
Last Name:GUMTANG
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1204
Mailing Address - Country:US
Mailing Address - Phone:201-467-9791
Mailing Address - Fax:
Practice Address - Street 1:70 AVENUE O
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6448
Practice Address - Country:US
Practice Address - Phone:347-576-1604
Practice Address - Fax:347-576-1607
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-15
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist