Individual
MRS. BETTY A GUMZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
155 WOODWARD ST, FOND DU LAC, WI 54935-4500
(920) 922-8456
Mailing address
155 WOODWARD ST, FOND DU LAC, WI 54935-4500
(920) 922-8456
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
673-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40161000
—
WI
Enumeration date
05/04/2007
Last updated
07/08/2007
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