Provider Demographics
NPI:1497872808
Name:GORBY, VERONIQUE MARGOT (LMT)
Entity Type:Individual
Prefix:MS
First Name:VERONIQUE
Middle Name:MARGOT
Last Name:GORBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 LOCUST AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1393
Mailing Address - Country:US
Mailing Address - Phone:304-367-9355
Mailing Address - Fax:304-367-9366
Practice Address - Street 1:1489 LOCUST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1393
Practice Address - Country:US
Practice Address - Phone:304-367-9355
Practice Address - Fax:304-367-9366
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist