Provider Demographics
NPI:1861539850
Name:GIBBS, CECILE (PT)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CECILE
Other - Middle Name:
Other - Last Name:CHENELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6 COMMERCIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5916
Mailing Address - Country:US
Mailing Address - Phone:410-449-3049
Mailing Address - Fax:
Practice Address - Street 1:6 COMMERCIAL PLZ
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5916
Practice Address - Country:US
Practice Address - Phone:410-449-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002504225100000X
MD21382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE138730Y5FMedicare PIN
MD138730Y5FMedicare PIN
MD138730ZBL8Medicare PIN
DE174236Y0XMedicare PIN