Provider Demographics
NPI:1629623426
Name:GIBBONS, ELIZABETH JOSEPHINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOSEPHINE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JO
Other - Last Name:CAMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5995 OPUS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9058
Mailing Address - Country:US
Mailing Address - Phone:952-300-3493
Mailing Address - Fax:763-260-7653
Practice Address - Street 1:2119 CLIFF RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2345
Practice Address - Country:US
Practice Address - Phone:651-688-7500
Practice Address - Fax:763-260-7653
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist