Healthcare Provider Details

I. General information

NPI: 1346128964
Provider Name (Legal Business Name): RYAN PATRICK GIBNEY PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S HAYS ST
BEL AIR MD
21014
US

IV. Provider business mailing address

16309 LITTLE RD
STEWARTSTOWN PA
17363-7423
US

V. Phone/Fax

Practice location:
  • Phone: 410-593-1815
  • Fax:
Mailing address:
  • Phone: 717-779-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number30413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: