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General NPI Number Information
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NPI Number | 1619288727
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Entity Type | Organization
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Legal Business Name | STABLE JOURNEYS, LLC
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 1571 WEST WOODBURY RD
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City | WOODBURY
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State | VT
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Zip | 05681
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Country | US
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Telephone | 802-760-7340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1204
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City | STOWE
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State | VT
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Zip | 05672-1204
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Country | US
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Telephone | 802-760-7340
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MS. HEIDI ELIESE WEHR-KUBALOVA
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Credential | P.T., M.S.
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Telephone | 802-760-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0400003611
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License Number State | VT
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