Individual
BO BLAINE GUMALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
605 MAIN ST, HACKENSACK, NJ 07601-5914
(201) 488-0488
(201) 488-5787
Mailing address
605 MAIN ST, HACKENSACK, NJ 07601-5914
(201) 488-0488
(201) 488-5787
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01873000
NJ
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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