Healthcare Provider Details

I. General information

NPI: 1306547989
Provider Name (Legal Business Name): MARIA GEINAH LABANERO GUMBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 27TH ST
ANACORTES WA
98221-2710
US

IV. Provider business mailing address

125 DALLAS ST
MOUNT VERNON WA
98274-3014
US

V. Phone/Fax

Practice location:
  • Phone: 360-293-3174
  • Fax:
Mailing address:
  • Phone: 360-630-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00010536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: