MEDICARE: MRS. MICHELE ANN GIBBS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006720L	PA

General Provider Information

NPI Number	:	1659339885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE ANN GIBBS P.T.

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

Provider Business Practice Location Address
First Line	:	2767 GERYVILLE PIKE
Second Line	:
City	:	PENNSBURG
State	:	PA
Zip	:	18073-2306
Country	:	US
Telephone Number	:	215-679-0105
Fax Number	:	215-679-0722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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