Individual provider Active NPI

Elayne Kay Geba, PT

  • Physical Therapist
  • Waterbury, VT
National Provider Identifier
1659619690
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
040.0134720 Issued in VT
Practice address
30 Foundry St Unit B
Waterbury, VT 05676-1503
Phone
(802) 560-8757
Fax
(484) 848-5190
NPI assigned
Jan 25, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT017667 PA
Physical Therapist 225100000X 40QA01350400 NJ
Physical Therapist 225100000X 040.0134720 VT Primary

Addresses

Primary practice location

30 Foundry St Unit B
Waterbury, VT 05676-1503

Mailing address

30 Foundry St Unit B
Waterbury, VT 05676-1503
Phone (802) 560-8757

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA01350400NJMDPhysical Therapist
PT017667PAMDPhysical Therapist
040.0134720VTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Wellness and Physical Therapy, Inc Physical Therapist CurrentSince Mar 20, 2022 Accepting new patients

Locations

785 Main St
Ste A
Half Moon Bay, CA 94019
Phone (650) 712-8400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1659619690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 FOUNDRY ST UNIT B",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761503",
            "telephone_number": "802-560-8757",
            "fax_number": "484-848-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 FOUNDRY ST UNIT B",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761503",
            "telephone_number": "802-560-8757",
            "fax_number": "484-848-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEBA",
        "first_name": "ELAYNE",
        "middle_name": "KAY",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-25",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT017667",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01350400",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040.0134720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.