Individual
MRS. JESSICA N GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
105 WINDSOR PATH STE 1, GEORGETOWN, GEORGETOWN, KY 40324-9617
(502) 570-2337
(502) 570-2338
Mailing address
124 STURBRIDGE DR, GEORGETOWN, GEORGETOWN, KY 40324-2536
(606) 424-7137
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005483
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000869196
ANTHEM
KY
05
—
7100300660
—
KY
Enumeration date
04/04/2014
Last updated
09/08/2014
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