Healthcare Provider Details

I. General information

NPI: 1639324759
Provider Name (Legal Business Name): LISA B GUMNIC PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 65TH ST SUITE 117
NEW YORK NY
10065-6743
US

IV. Provider business mailing address

160 E 88TH ST 5J
NEW YORK NY
10128-2233
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-2588
  • Fax:
Mailing address:
  • Phone: 732-580-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number029367-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: