Provider Demographics
NPI:1629444799
Name:GIBSON, JANELLE (DPT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2404
Mailing Address - Country:US
Mailing Address - Phone:806-236-3124
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:BUILDING 2, SUITE 232
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:406-200-8488
Practice Address - Fax:406-213-3518
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013541225100000X
TX1262305225100000X
MT19266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist