Individual
DR. MARK KEVIN GUMTANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2512 SE 109TH AVE, PORTLAND, OR 97266-1215
(503) 388-3755
Mailing address
7067 SE BLANTON ST APT 5304, HILLSBORO, OR 97123-2701
(808) 282-1195
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
64108
OR
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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