Provider Demographics
NPI:1033449285
Name:GEBERTH, PATRICIA JOAN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:GEBERTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SCARLET OAK CIR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7920
Mailing Address - Country:US
Mailing Address - Phone:540-720-8642
Mailing Address - Fax:
Practice Address - Street 1:5040 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6647
Practice Address - Country:US
Practice Address - Phone:540-786-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist