Provider Demographics
NPI:1730592049
Name:GIBBONS, CAITLIN ANN (PT)
Entity type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:ANN
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2815 DUSTIN RD
Mailing Address - Street 2:SUTIE 8
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3497
Mailing Address - Country:US
Mailing Address - Phone:419-693-0676
Mailing Address - Fax:419-693-0807
Practice Address - Street 1:4747 SUDER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2869
Practice Address - Country:US
Practice Address - Phone:419-720-0100
Practice Address - Fax:419-720-0019
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHPT.014851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist