Healthcare Provider Details

I. General information

NPI: 1619273380
Provider Name (Legal Business Name): RACHAEL A GUMM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVE
AMES IA
50010-5469
US

IV. Provider business mailing address

N84W16889 MENOMONEE AVE
MENOMONEE FALLS WI
53051-2810
US

V. Phone/Fax

Practice location:
  • Phone: 515-956-4095
  • Fax: 515-956-4093
Mailing address:
  • Phone: 262-251-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-018273
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP16218
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14102
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: