NPIMap

Individual provider Active NPI

Renee L Gibson, MSPT

  • Physical Therapist
  • Hamilton, MT
National Provider Identifier
1639390495
Registry record updated Aug 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1909 Issued in MT
Practice address
336 Fairgrounds Rd
Hamilton, MT 59840-3126
Phone
(406) 375-9034
Fax
(406) 375-9938
NPI assigned
May 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1909 MT Primary

Addresses

Primary practice location

336 Fairgrounds Rd
Hamilton, MT 59840-3126

Mailing address

2207 Wylie Ave
Missoula, MT 59802-3533
Phone (406) 544-9344

Other identifiers 1

IdentifierTypeStateIssuer
1639390495MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250710000411 ID Practitioner - Physical Therapist in Private Practice 0446205066 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1909MTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Land Rehabilitation LLC Physical Therapist CurrentSince Jun 20, 2025 Accepting new patients
Moving Mountains Therapy Center, PLLC Physical Therapist CurrentSince Oct 21, 2024 Accepting new patients
Registered Physical Therapists LLC Past Accepting new patients
Peak Performance Physical Therapy PC Physical Therapist PastSince Jul 19, 1996 Accepting new patients
The Center of Physical Therapy & Wellness Past Accepting new patients
Frenchtown Physical Therapy Inc PastSince Sep 23, 2013 Accepting new patients
Center for Physical Therapy & Wellness Inc PastSince Oct 16, 2006 Accepting new patients
Seeley Swan Pharmacy Inc Past Accepting new patients

Locations

912 S Washington Ave
Emmett, ID 83617
Phone (208) 365-4400

1800 Flandro Dr
Ste 190
Pocatello, ID 83202
Phone (208) 233-2248

700 SW Higgins Ave
Ste 103
Missoula, MT 59803
Phone (406) 396-4130

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1639390495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 WYLIE AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598023533",
            "telephone_number": "406-544-9344",
            "fax_number": "406-375-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 FAIRGROUNDS RD",
            "city": "HAMILTON",
            "state": "MT",
            "postal_code": "598403126",
            "telephone_number": "406-375-9034",
            "fax_number": "406-375-9938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "RENEE",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "1909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639390495",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.