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General NPI Number Information
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NPI Number | 1023624269
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Entity Type | Individual
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Provider Name | JESSILYN GIBAS
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Gender | Female
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 45 WELLS PLZ STE 10
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City | WELLS
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State | ME
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Zip | 04090-4146
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Country | US
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Telephone | 207-641-2292
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Fax |
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Provider Business Mailing Address
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Address Line | 45 WELLS PLZ STE 10
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City | WELLS
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State | ME
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Zip | 04090-4146
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.025477
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305216863
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05015741A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT7206
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License Number State | ME
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