Provider Demographics
NPI:1083752976
Name:WEHR-KUBALOVA, HEIDI E (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:E
Last Name:WEHR-KUBALOVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-1204
Mailing Address - Country:US
Mailing Address - Phone:802-760-7340
Mailing Address - Fax:
Practice Address - Street 1:147 S MAIN ST
Practice Address - Street 2:#2B
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-5198
Practice Address - Country:US
Practice Address - Phone:802-760-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist