Individual
JEANETTE GIBSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
13537 BARRETT PARKWAY DR, STE 205, MANCHESTER, MO 63021-5899
(314) 966-2273
Mailing address
5314 HAGEMANN CROSSING DR, SAINT LOUIS, MO 63128-4268
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01686
LICENSE #
MO
Enumeration date
03/28/2006
Last updated
07/08/2007
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