Dale Robert Gibbs, DPT
Individual provider Active NPI Physical Therapist · Mountain Home, ID
NPI 1407375405 · NPPES record last updated Sep 12, 2017
Key facts
- NPI
- 1407375405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-5372 (ID)
- Practice address
- 1005 W 6TH S
Mountain Home, ID 83647-3339 - Phone
- (208) 587-1777
- Fax
- (208) 587-1784
- NPI assigned
- Sep 12, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221130003555 | SC | Practitioner - Physical Therapist in Private Practice | 5597022020 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenville Proaxis Therapy, LLC | Physical Therapist | Current |
Accepting new patients |
| Greenville Proaxis Therapy LLC | Current |
Accepting new patients | |
| McCall Physical Therapy, P.a. | Physical Therapist | Past | Accepting new patients |
Locations
790 Remington Blvd
Bolingbrook, IL 60440
33205 Collection Ctr Dr
Chicago, IL 60693
838 Powdersville Rd
Ste T
Easley, SC 29642
Phone (864) 671-1650
103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-5372 | ID | Yes |
Addresses
Primary practice location
1005 W 6TH S
Mountain Home, ID 83647-3339
Mailing address
7550 W Emerald St
Boise, ID 83704-9015
Phone (208) 375-0666
Other providers in Mountain Home, ID
- Karen Anne Galvan
- Alejandra Garcia
- Anna Marie Garvin
- Darin K Gere
- Jeffrey Eugene Gibbons
- Jacob Gibson
- Steven Gigli
- Colleen M Gingerich
- Glenns Ferry Health Center, Inc.
- Glenns Ferry Health Center, Inc.
All providers in Mountain Home, ID · Physical Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.