Jacob Gibson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-6700 Issued in NU

Practice address

245 N 3Rd E
Mountain Home, ID 83647-2734

Phone

(208) 587-8255

Fax

(208) 587-4475

NPI assigned

Jul 9, 2020

Last updated

Jul 9, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Therapy Care PLLC

  • Hearing and Speech Clinic/Center
  • Mountain Home, ID
  • NPI 1477786358
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1366060956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 N 3RD E",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836472734",
            "telephone_number": "208-587-8255",
            "fax_number": "208-587-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N 3RD E",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836472734",
            "telephone_number": "208-587-8255",
            "fax_number": "208-587-4475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "68 S Baltic Pl",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836425935",
            "country_code": "US",
            "telephone_number": "208-898-0988",
            "fax_number": "208-898-9022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-09",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": "PT-6700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alejandra Garcia, RDH
• Anna Marie Garvin, RN
• Darin K Gere, LCSW
• Jeffrey Eugene Gibbons, OD
• Dale Robert Gibbs, DPT
• Steven Gigli, DDS
• Colleen M Gingerich, LPC
• Glenns Ferry Health Center, Inc. (Desert Sage Health Centers)
• Glenns Ferry Health Center, Inc. (Desert Sage Pharmacy)
• Glenns Ferry Health Center, Inc. (Desert Sage Health Centers)

• Physical Therapist in Mountain Home, ID
• Providers in Mountain Home, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.