Provider Demographics
NPI:1427651843
Name:KILEY COLEMAN GIBBS PEDIATRIC PHYSICAL THERAPY
Entity type:Organization
Organization Name:KILEY COLEMAN GIBBS PEDIATRIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MA, PCS
Authorized Official - Phone:240-377-6179
Mailing Address - Street 1:19208 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21758-1344
Mailing Address - Country:US
Mailing Address - Phone:240-377-6179
Mailing Address - Fax:240-397-5370
Practice Address - Street 1:21631 RIDGETOP CIR STE 225A
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6742
Practice Address - Country:US
Practice Address - Phone:240-377-6179
Practice Address - Fax:240-397-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No252Y00000XAgenciesEarly Intervention Provider Agency