Provider Demographics
NPI:1003826207
Name:GIBB, JARED (PT)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:GIBB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E STATE PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4569
Mailing Address - Country:US
Mailing Address - Phone:630-285-8007
Mailing Address - Fax:630-285-8017
Practice Address - Street 1:1440 W NORTH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1422
Practice Address - Country:US
Practice Address - Phone:708-865-8600
Practice Address - Fax:708-865-8661
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL070-014535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist