Provider Demographics
NPI:1821299231
Name:GABUT, BARBARA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:GABUT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 DUNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-1512
Mailing Address - Country:US
Mailing Address - Phone:509-628-7209
Mailing Address - Fax:
Practice Address - Street 1:8840 CYPRESS WATERS BLVD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4594
Practice Address - Country:US
Practice Address - Phone:800-788-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAPTA 00738174400000X
ORPTA 8459174400000X
AZPTA 7963A174400000X
NVPTA A-0446174400000X
TXPTA 2070020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist