Individual
WILLIAM LANE GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1661 WOODARD AVE APT 723, CLEBURNE, TX 76033-7058
(325) 977-2395
Mailing address
2820 W FREY ST APT 7108, STEPHENVILLE, TX 76401-1905
(325) 977-2395
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT7872
TX
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
08/24/2018
Last updated
01/27/2020
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