1659339885 NPI number — MRS. MICHELE ANN GIBBS P.T.

Table of content: MRS. MICHELE ANN GIBBS P.T. (NPI 1659339885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659339885 NPI number — MRS. MICHELE ANN GIBBS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
MICHELE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHWENK
Provider Other First Name:
MICHELE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659339885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 LLOYD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENNSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18073-1723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-679-0432
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2767 GERYVILLE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18073-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-679-0105
Provider Business Practice Location Address Fax Number:
215-679-0722
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT006720L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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