Individual
JASON WILDE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, AT
Contact information
Practice address
7800 W OUTER DR, DETROIT, MI 48235-3461
(313) 543-6295
Mailing address
45057 GOV BRADFORD, PLYMOUTH, MI 48170-3713
(248) 561-1440
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501009462
MI
Other
Enumeration date
02/26/2018
Last updated
03/12/2021
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