Provider Demographics
NPI:1932769221
Name:GEREBEN, MATTIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:GEREBEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5965
Mailing Address - Country:US
Mailing Address - Phone:470-533-4200
Mailing Address - Fax:
Practice Address - Street 1:1165 SANDERS RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5965
Practice Address - Country:US
Practice Address - Phone:704-533-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist