Healthcare Provider Details

I. General information

NPI: 1710184585
Provider Name (Legal Business Name): VALERIE ANNE GUMBLETON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38777 6 MILE RD SUITE 209
LIVONIA MI
48152-2694
US

IV. Provider business mailing address

1291 TREVINO DR
TROY MI
48085-3393
US

V. Phone/Fax

Practice location:
  • Phone: 888-414-7056
  • Fax: 877-414-9925
Mailing address:
  • Phone: 248-879-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberL942581
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: