Healthcare Provider Details

I. General information

NPI: 1285051938
Provider Name (Legal Business Name): TAMERA S GEBO-WILBER PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 STOCKBRIDGE ROAD
GREAT BARRINGTON MA
01230
US

IV. Provider business mailing address

P.O. BOX 30 444 STOCKBRIDGE ROAD
GREAT BARRINGTON MA
01230-0030
US

V. Phone/Fax

Practice location:
  • Phone: 412-528-8580
  • Fax: 413-528-8583
Mailing address:
  • Phone: 412-528-8580
  • Fax: 413-528-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6718
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: