Individual
DANIELLE E. GIPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2627 RIVERSIDE AVE FL 3, JACKSONVILLE, FL 32204-4712
(904) 634-0640
(904) 634-0203
Mailing address
6500 BOWDEN RD STE 103, JACKSONVILLE, FL 32216-8066
(904) 634-0640
(904) 634-0203
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA27291
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA27291
LICENSE
FL
Enumeration date
08/10/2017
Last updated
08/10/2017
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