Provider Demographics
NPI:1285623181
Name:GIBBS, TIMOTHY J (PT, OCS, CERT MDT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:GIBBS
Suffix:
Gender:M
Credentials:PT, OCS, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COMMONS LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1904
Mailing Address - Country:US
Mailing Address - Phone:406-752-7250
Mailing Address - Fax:406-752-6250
Practice Address - Street 1:175 COMMONS LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1904
Practice Address - Country:US
Practice Address - Phone:406-752-7250
Practice Address - Fax:406-752-6250
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1141PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBCBS OF MTOtherPROVIDER NUMBER
MTP00380494OtherRAILROAD MEDICARE
MTWA STATE COMP FUNDOtherPROVIDER # FOR WA PATIENT
MT0049348Medicaid
MTMT STATE FUNDOtherPROVIDER NUMBER
MTWA STATE COMP FUNDOtherPROVIDER # FOR WA PATIENT