Basic Information
| Provider Information | |||||||||
| NPI: | 1891912101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUBAN | ||||||||
| FirstName: | WILMA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 MANSFIELD PL | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027736698 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 HAYWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027476433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 040-0003617 | VT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 15440 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.