Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 66P88323 | NY |
NPI | 1013355858 |
---|---|
Provider Name | Drew Gibson |
First Address | Jamestown, NY 14701-6626 |
Second Address | Jamestown, NY 14701-6626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2013 |
Last Update Date | 13/06/2013 |