Provider Demographics
NPI:1659339885
Name:GIBBS, MICHELE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:ANN
Other - Last Name:SCHWENK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1608 LLOYD LN
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1723
Mailing Address - Country:US
Mailing Address - Phone:215-679-0432
Mailing Address - Fax:
Practice Address - Street 1:2767 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:215-679-0105
Practice Address - Fax:215-679-0722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006720L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist