Provider Demographics
NPI:1467799957
Name:GIBBONS, PAMELA SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SCOTT
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2049 BARBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-4179
Mailing Address - Country:US
Mailing Address - Phone:970-270-4015
Mailing Address - Fax:
Practice Address - Street 1:2049 BARBERRY AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8150
Practice Address - Country:US
Practice Address - Phone:970-270-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0002185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist