Individual
JACOB GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
245 N 3RD E, MOUNTAIN HOME, ID 83647-2734
(208) 587-8255
(208) 587-4475
Mailing address
245 N 3RD E, MOUNTAIN HOME, ID 83647-2734
(208) 587-8255
(208) 587-4475
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6700
—
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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