Provider Demographics
NPI:1912300377
Name:GIBBS, KILEY COLEMAN (PT, DPT, MA, PCS)
Entity type:Individual
Prefix:DR
First Name:KILEY
Middle Name:COLEMAN
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PT, DPT, MA, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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
Practice Address - Country:US
Practice Address - Phone:240-377-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052115292251P0200X
MD269382251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics