Provider Demographics
NPI:1376587949
Name:GIMBLE, JUDITH LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNNE
Last Name:GIMBLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-8562
Mailing Address - Country:US
Mailing Address - Phone:724-865-2087
Mailing Address - Fax:
Practice Address - Street 1:563 KELLY BLVD
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1155
Practice Address - Country:US
Practice Address - Phone:724-794-1039
Practice Address - Fax:724-794-5936
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005918L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist