Healthcare Provider Details

I. General information

NPI: 1336682087
Provider Name (Legal Business Name): MARTA GUMBER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 LAKELAND HIGHLANDS RD
LAKELAND FL
33813-3113
US

IV. Provider business mailing address

739 HOLLINGSWORTH RD
LAKELAND FL
33801-5817
US

V. Phone/Fax

Practice location:
  • Phone: 458-229-6295
  • Fax:
Mailing address:
  • Phone: 458-229-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: