Individual
AUTUMN GIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4409 W WADLEY AVE, MIDLAND, TX 79707-5328
(432) 617-3110
(432) 617-3112
Mailing address
5000 HANOVER DR, ODESSA, TX 79761-2239
(432) 550-4700
(432) 550-4715
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1407646
TX
Other
Enumeration date
11/24/2025
Last updated
11/24/2025
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