Healthcare Provider Details

I. General information

NPI: 1760105332
Provider Name (Legal Business Name): SALIM GUMATI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EXECUTIVE CT
YREKA CA
96097-2629
US

IV. Provider business mailing address

205 EXECUTIVE CT
YREKA CA
96097-2629
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-4381
  • Fax:
Mailing address:
  • Phone: 530-842-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: