Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1112365 | TX |
N | 225CA2400X | Assistive Technology Practitioner | 92969 | TX |
NPI | 1609836675 |
---|---|
Provider Name | Wendy Mckinney Gibbs |
First Address | Magnolia, TX 77355-5370 |
Second Address | Magnolia, TX 77355-5370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 16/10/2020 |