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Individual

BRYAN J. GIBBY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSPT, CWS

Contact information

Practice address
1492 CHRISTENSEN DR, BLACKFOOT, ID 83221-3707
(208) 240-7221
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-3883

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
292356-2401
UT
225100000X
Physical Therapist
Primary
PT-1780
ID

Other

Enumeration date
04/30/2009
Last updated
04/28/2013
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