Provider Demographics
NPI:1609421023
Name:GIBBS, TYLER MONTANA (DPT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:MONTANA
Last Name:GIBBS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 LEAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3349
Mailing Address - Country:US
Mailing Address - Phone:502-223-7403
Mailing Address - Fax:502-223-5016
Practice Address - Street 1:1004 LEAWOOD DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3349
Practice Address - Country:US
Practice Address - Phone:502-223-7403
Practice Address - Fax:502-223-5016
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007739OtherKENTUCKY BOARD OF PHYSICAL THERAPY