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Individual
MR. RODNEY T GIBSON
Active
Individual
MR. RODNEY T GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, PED.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002269
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000879623A
—
GA
01
—
58-1838574
TAX PROVIDER NUMBER
GA
01
—
ACS157060500
OWCP PROVIDER NUMBER
GA
Enumeration date
10/03/2006
Last updated
10/21/2011
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