Provider Demographics
NPI:1760767883
Name:GUBERMAN, MITCHELL (DPT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:GUBERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20333 STATE HIGHWAY 249
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2613
Mailing Address - Country:US
Mailing Address - Phone:305-978-0525
Mailing Address - Fax:
Practice Address - Street 1:5771 ENID ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-1208
Practice Address - Country:US
Practice Address - Phone:713-880-4400
Practice Address - Fax:713-869-8637
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist