Provider Demographics
NPI:1184118374
Name:GIBBENS, PAIGE (DPT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:GIBBENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:KOEBBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1317 E REPUBLIC RD STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7237
Mailing Address - Country:US
Mailing Address - Phone:417-881-9333
Mailing Address - Fax:417-881-9334
Practice Address - Street 1:1317 E REPUBLIC RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7237
Practice Address - Country:US
Practice Address - Phone:417-881-9333
Practice Address - Fax:417-881-9334
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018021490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist