Provider Demographics
NPI:1699326512
Name:GILBERTIE, MITCHELL (PT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:GILBERTIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HIGHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-1118
Mailing Address - Country:US
Mailing Address - Phone:203-644-7889
Mailing Address - Fax:
Practice Address - Street 1:19 OLD KINGS HWY S STE 120
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4532
Practice Address - Country:US
Practice Address - Phone:203-621-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT123192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic