# GIBBONS PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902382575
- **Authorized official:** SUSAN GIBBONS DPT (OWNER/PT)
- **Authorized official phone:** (503) 512-9140

## Contact information

- **Practice address:** 10151 SE 100TH DR, HAPPY VALLEY, OR 97086-7240
- **Practice address phone:** (503) 512-9140
- **Mailing address:** 15505 NE 5TH ST, VANCOUVER, WA 98684-3376
- **Mailing address phone:** (503) 512-9140
- **Mailing address fax:** (503) 912-7007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 5974 | OR | Yes |

## Other

- **Enumeration date:** 07/17/2018
- **Last updated:** 07/17/2018