Provider Demographics
NPI:1871935916
Name:GIBBS, LAURA HEGSTROM (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:HEGSTROM
Last Name:GIBBS
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 AKRON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3743
Mailing Address - Country:US
Mailing Address - Phone:210-823-6613
Mailing Address - Fax:
Practice Address - Street 1:5040 AKRON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3743
Practice Address - Country:US
Practice Address - Phone:210-823-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218051225100000X
COPTL.0015320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist