Healthcare Provider Details

I. General information

NPI: 1033449285
Provider Name (Legal Business Name): PATRICIA JOAN GEBERTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 PLANK RD
FREDERICKSBURG VA
22407-6647
US

IV. Provider business mailing address

7 SCARLET OAK CIR
STAFFORD VA
22554-7920
US

V. Phone/Fax

Practice location:
  • Phone: 540-786-4549
  • Fax:
Mailing address:
  • Phone: 540-720-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305003077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: