Individual
KYLE MARK GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
1440 MONROE ST, MADISON, WI 53711-2051
(608) 301-7672
Mailing address
1440 MONROE ST, MADISON, WI 53711-2051
(608) 301-7672
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1124-039
WI
Other
Enumeration date
11/07/2011
Last updated
07/02/2013
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