Provider Demographics
NPI:1801377825
Name:VAN BOVEN, GURUBANI WHITNEY A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GURUBANI WHITNEY
Middle Name:A
Last Name:VAN BOVEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:GURUBANI WHITNEY
Other - Middle Name:A
Other - Last Name:KHALSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WEMT, CPHT
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98283-0074
Mailing Address - Country:US
Mailing Address - Phone:865-455-3453
Mailing Address - Fax:
Practice Address - Street 1:320 E FAIRHAVEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1700
Practice Address - Country:US
Practice Address - Phone:865-455-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty