Provider Demographics
NPI:1215924873
Name:GIMBEL, MARY ANN (PT, CHT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:GIMBEL
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4431
Mailing Address - Country:US
Mailing Address - Phone:570-668-1889
Mailing Address - Fax:570-668-6115
Practice Address - Street 1:219 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4431
Practice Address - Country:US
Practice Address - Phone:570-668-1889
Practice Address - Fax:570-668-6115
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003911L225100000X
2251H1200X, 2251X0800X, 2251E1200X, 2251G0304X, 2251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
11227707OtherCAQH
22957OtherKEYSTONE
64762000OtherINDEPENDENCE BLUE CROSS
5051573OtherAETNA PPO
202758OtherHEALTH ASSURANCE
01401402OtherCAPITAL BLUE CROSS
800156OtherFIRST PRIORITY
22957OtherHIGHMARK BLUE SHIELD
2106685OtherAETNA HMO
22957M1LMedicare ID - Type Unspecified
01401402OtherCAPITAL BLUE CROSS