Provider Demographics
NPI:1528305968
Name:GIBBONS, SARAH B (DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:B
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:303-792-7377
Mailing Address - Fax:303-792-9077
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:303-792-7377
Practice Address - Fax:303-792-9077
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3741574YNXYMedicare PIN