Provider Demographics
NPI:1720411739
Name:GILBERT, TRACI (LPT)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 13TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1883
Mailing Address - Country:US
Mailing Address - Phone:812-482-7441
Mailing Address - Fax:812-482-7444
Practice Address - Street 1:600 W 13TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1883
Practice Address - Country:US
Practice Address - Phone:812-482-7441
Practice Address - Fax:812-482-7444
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011229A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist