Provider Demographics
NPI:1447547252
Name:GEHEB, KASEY (PTA)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:GEHEB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-0338
Mailing Address - Country:US
Mailing Address - Phone:479-926-3993
Mailing Address - Fax:
Practice Address - Street 1:1202 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-4560
Practice Address - Country:US
Practice Address - Phone:479-474-6444
Practice Address - Fax:479-474-6446
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2530225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant