Basic Information
| Provider Information | |||||||||
| NPI: | 1821299231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GABUT | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3324 DUNE DR | ||||||||
| Address2: | |||||||||
| City: | LAKE HAVASU CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864041512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096287209 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8840 CYPRESS WATERS BLVD | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750194594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007884815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 10/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PTA 00738 | IA | N | Other Service Providers | Specialist | 174400000X | PTA 8459 | OR | N | Other Service Providers | Specialist | 174400000X | PTA 7963A | AZ | Y | Other Service Providers | Specialist | 174400000X | PTA A-0446 | NV | N | Other Service Providers | Specialist | 174400000X | PTA 2070020 | TX | N | Other Service Providers | Specialist |
No ID Information.