Provider Demographics
NPI:1063698678
Name:GIBBS, MITZIE RENEE (MPT)
Entity type:Individual
Prefix:MRS
First Name:MITZIE
Middle Name:RENEE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19964 HILLTOP RD STE B
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7317
Mailing Address - Country:US
Mailing Address - Phone:303-840-4667
Mailing Address - Fax:303-840-4658
Practice Address - Street 1:19964 HILLTOP RD STE B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7317
Practice Address - Country:US
Practice Address - Phone:303-840-4667
Practice Address - Fax:303-840-4658
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26261225100000X
CO9261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811568Medicare UPIN