Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 10499 | AZ |
NPI | 1083000129 |
---|---|
Provider Name | Nadine Gibson |
First Address | Chandler, AZ 85224-2713 |
Second Address | Mesa, AZ 85207-3705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 18/05/2015 |