Individual
TRACI GIBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
W197N16960 STONEWALL DR, JACKSON, WI 53037-8617
(414) 750-9393
Mailing address
W197N16960 STONEWALL DR, JACKSON, WI 53037-8617
(414) 750-9393
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1475-39
WI
Other
Enumeration date
12/14/2014
Last updated
07/14/2020
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