Provider Demographics
NPI:1659256345
Name:GIBBENS, RACHEL LYNNE (DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNNE
Last Name:GIBBENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 W STATE HIGHWAY O
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-5742
Mailing Address - Country:US
Mailing Address - Phone:217-621-0293
Mailing Address - Fax:
Practice Address - Street 1:405 FARMER RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9509
Practice Address - Country:US
Practice Address - Phone:417-742-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017026975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist