Provider Demographics
NPI:1184903858
Name:GUBBELS, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GUBBELS
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 1:703 SOUTH VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:WAUSA
Mailing Address - State:NE
Mailing Address - Zip Code:68786
Mailing Address - Country:US
Mailing Address - Phone:402-586-2359
Mailing Address - Fax:402-586-2352
Practice Address - Street 1:703 SOUTH VIVIAN ST
Practice Address - Street 2:
Practice Address - City:WAUSA
Practice Address - State:NE
Practice Address - Zip Code:68786
Practice Address - Country:US
Practice Address - Phone:402-586-2359
Practice Address - Fax:402-586-2352
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE872208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation