Healthcare Provider Details

I. General information

NPI: 1275926941
Provider Name (Legal Business Name): CHRISTEN GUMBS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W SLAUGHTER LN STE 475
AUSTIN TX
78748-6230
US

IV. Provider business mailing address

1807 W SLAUGHTER LN STE 475
AUSTIN TX
78748-6230
US

V. Phone/Fax

Practice location:
  • Phone: 512-520-4242
  • Fax: 512-782-0287
Mailing address:
  • Phone: 512-520-4242
  • Fax: 512-782-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1255397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: