Provider Demographics
NPI:1467995480
Name:GILBERT, PENNY (ATC, LAT, EMT)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:ATC, LAT, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7704
Mailing Address - Street 2:DEPARTMENT 832
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67277-7704
Mailing Address - Country:US
Mailing Address - Phone:316-517-2746
Mailing Address - Fax:
Practice Address - Street 1:1 CESSNA BLVD
Practice Address - Street 2:HEALTH SERVICES
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67215-1400
Practice Address - Country:US
Practice Address - Phone:316-517-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-001292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer