Healthcare Provider Details

I. General information

NPI: 1881817419
Provider Name (Legal Business Name): FELIPE PEREZ GUMAWID JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 N 19TH ST
ABILENE TX
79601-2316
US

IV. Provider business mailing address

3934 RIDGMAR LN
ABILENE TX
79606-2690
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-2000
  • Fax:
Mailing address:
  • Phone: 325-695-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1065167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: