Healthcare Provider Details

I. General information

NPI: 1225728694
Provider Name (Legal Business Name): RACHEL GUMOWSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LITTLE PLAINS RD
HUNTINGTON NY
11743-4550
US

IV. Provider business mailing address

488 HEATHCOTE RD
LINDENHURST NY
11757-1820
US

V. Phone/Fax

Practice location:
  • Phone: 631-266-4441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: