Provider Demographics
NPI:1053076141
Name:GIBBS, JESSICA LEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CORBIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2911
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:2900 S DANVILLE BYP STE 110
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2464
Practice Address - Country:US
Practice Address - Phone:859-209-2049
Practice Address - Fax:859-209-2253
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008419OtherSTATE LICENSE