Provider Demographics
NPI:1053602243
Name:MUMME, ROSE G (PT)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:G
Last Name:MUMME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 BELFRY CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5232
Mailing Address - Country:US
Mailing Address - Phone:281-398-1260
Mailing Address - Fax:
Practice Address - Street 1:4102 BELFRY CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5232
Practice Address - Country:US
Practice Address - Phone:281-398-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist