Basic Information
| Provider Information | |||||||||
| NPI: | 1003155250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMMEL | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 POWDERHORN | ||||||||
| Address2: | |||||||||
| City: | HORSESHOE BAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786575981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302658540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 705 1ST ST STE 207 | ||||||||
| Address2: | |||||||||
| City: | MARBLE FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786545757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122890219 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MT045436 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.