Provider Demographics
NPI:1710262787
Name:GAMBOA, JUDITH SALONGA
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SALONGA
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 FRIENDS CIR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4740
Mailing Address - Country:US
Mailing Address - Phone:141-058-5438
Mailing Address - Fax:
Practice Address - Street 1:1920 TROLLEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-1018
Practice Address - Country:US
Practice Address - Phone:410-585-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009038481225100000X
PA020347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA020347OtherPHYSICAL THERAPIST LICENSE