Provider Demographics
NPI:1992163737
Name:GILBERT, FREDERICK
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SE TACOMA ST UNIT 122
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6639
Mailing Address - Country:US
Mailing Address - Phone:971-361-9442
Mailing Address - Fax:888-645-6068
Practice Address - Street 1:1327 SE TACOMA ST UNIT 122
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6639
Practice Address - Country:US
Practice Address - Phone:971-361-9442
Practice Address - Fax:888-645-6068
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872220225100000X
VA2305211681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist