MEDICARE: MITCHELL GUBERMAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1210461	TX

General Provider Information

NPI Number	:	1760767883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL GUBERMAN DPT

Provider Business Mailing Address
First Line	:	20333 STATE HIGHWAY 249
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77070-2613
Country	:	US
Telephone Number	:	305-978-0525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5771 ENID ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-1208
Country	:	US
Telephone Number	:	713-880-4400
Fax Number	:	713-869-8637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	08/03/2020

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