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General NPI Number Information
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NPI Number | 1659619690
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Entity Type | Individual
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Provider Name | ELAYNE KAY GEBA PT
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Gender | Female
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 30 FOUNDRY ST UNIT B
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City | WATERBURY
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State | VT
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Zip | 05676-1503
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Country | US
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Telephone | 802-560-8757
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Fax | 484-848-5190
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Provider Business Mailing Address
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Address Line | 30 FOUNDRY ST UNIT B
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City | WATERBURY
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State | VT
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Zip | 05676-1503
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Country | US
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Telephone | 802-560-8757
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Fax | 484-848-5190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT017667
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01350400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 040.0134720
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License Number State | VT
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