Provider Demographics
NPI:1659619690
Name:GEBA, ELAYNE KAY (PT)
Entity type:Individual
Prefix:
First Name:ELAYNE
Middle Name:KAY
Last Name:GEBA
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 1:30 FOUNDRY ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1503
Mailing Address - Country:US
Mailing Address - Phone:802-560-8757
Mailing Address - Fax:484-848-5190
Practice Address - Street 1:30 FOUNDRY ST UNIT B
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1503
Practice Address - Country:US
Practice Address - Phone:802-560-8757
Practice Address - Fax:484-848-5190
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017667225100000X
NJ40QA01350400225100000X
VT040.0134720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist