Provider Demographics
NPI:1164553848
Name:GILBERT, DENNIS TRACY (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:TRACY
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 CREEK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRUIT HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2665
Mailing Address - Country:US
Mailing Address - Phone:801-597-0522
Mailing Address - Fax:801-732-2130
Practice Address - Street 1:4607 MIDLAND DR
Practice Address - Street 2:SUIT 201
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9507
Practice Address - Country:US
Practice Address - Phone:801-732-8700
Practice Address - Fax:801-732-2103
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2849052401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist