Provider Demographics
NPI:1801405543
Name:SALIGUMBA, VAN GAMIT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:GAMIT
Last Name:SALIGUMBA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 INDEPENDENCE AVE APT 5J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1414
Mailing Address - Country:US
Mailing Address - Phone:347-847-7717
Mailing Address - Fax:
Practice Address - Street 1:3777 INDEPENDENCE AVE APT 5J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1414
Practice Address - Country:US
Practice Address - Phone:347-847-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty