Provider Demographics
NPI:1427387380
Name:GIBBS, JENNIFER M (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 TYEE RD
Mailing Address - Street 2:
Mailing Address - City:UMPQUA
Mailing Address - State:OR
Mailing Address - Zip Code:97486-9723
Mailing Address - Country:US
Mailing Address - Phone:541-817-6848
Mailing Address - Fax:541-767-2751
Practice Address - Street 1:1931 NW MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470
Practice Address - Country:US
Practice Address - Phone:541-672-5795
Practice Address - Fax:423-602-2028
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26087225700000X
OR3255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist