Individual
AMY GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC LAT
Contact information
Practice address
7050 S 24TH ST, PHOENIX, AZ 85042-5806
(602) 243-8232
Mailing address
4776 E GUADALUPE RD, APT 2045, GILBERT, AZ 85234-7501
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
1299
AZ
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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