Provider Demographics
NPI:1619273380
Name:GUMM, RACHAEL A (DPT)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:GUMM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N84W16889 MENOMONEE AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2810
Mailing Address - Country:US
Mailing Address - Phone:262-251-7500
Mailing Address - Fax:
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5469
Practice Address - Country:US
Practice Address - Phone:515-956-4095
Practice Address - Fax:515-956-4093
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018273225100000X
NCP162182251X0800X
WI14102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-018273OtherSTATE PHYSICAL THERAPY LICENSE
NCP16218OtherSTATE PHYSICAL THERAPY LICENSE