Healthcare Provider Details

I. General information

NPI: 1376012450
Provider Name (Legal Business Name): COURTNEY ANNE GUMPRECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2018
Last Update Date: 11/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 COLUMBIA ST
COHOES NY
12047-2217
US

IV. Provider business mailing address

180 POWELL HILL RD
RAVENA NY
12143-2705
US

V. Phone/Fax

Practice location:
  • Phone: 518-237-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number009580-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: