| Doctor Name: | DAVID LEOR GUSTAFSON |
| NPI Number: | 1316379308 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | PT011099 |
| Business Practice Address: | 600 Chastain Rd Nw Ste 428 Kennesaw, GA - 301443210 |
| Business Phone Number: | 7704236701 |
| Business Fax Number: | 7709161785 |
| Mailing Address: | 8823 Production Ln, OOLTEWAH |
| State: | TN |
| Postal Code: | 373636511 |
| Phone Number: | 4232387217 |
| Fax Number: | 4232383473 |
| NPI Enumeration Date: | 08/01/2013 |
| NPI Last Update Date: | 08/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT011099 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |