Basic Information
| Provider Information | |||||||||
| NPI: | 1003826207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBB | ||||||||
| FirstName: | JARED | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 E STATE PKWY | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302858007 | ||||||||
| FaxNumber: | 6302858017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 W NORTH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601601422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088658600 | ||||||||
| FaxNumber: | 7088658661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-014535 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.