Jill Susanne Gibson, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT36639 Issued in CA

Practice address

1570 E 17TH St
Santa Ana, CA 92705-8502

Phone

(714) 834-1111

Fax

(714) 972-0454

NPI assigned

Mar 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jill Susanne Gibson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1477672095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6674 CORTE EDUARDO",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920094566",
            "telephone_number": "805-931-4435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 E 17TH ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927058502",
            "telephone_number": "714-834-1111",
            "fax_number": "714-972-0454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JILL",
        "middle_name": "SUSANNE",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT36639",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P14505",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "GIBSON",
            "middle_name": "SUSANNE",
            "credential": "P.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carolyn Giardini, QASP
• Daniel Aaron Gibbs
• Jacqueline Gibbs
• Barbara Faye Gibson-Paul, MFT
• Carroline Rose Gibson
• Robert North Gibson, P.A.
• Amy Crystal Giese, FNP
• Giggle Play Grow Speech Therapy Solutions Corporation
• Star L Gil Richter Schmid
• Crystal Gil

• Physical Therapist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; 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.