Individual
ANGELA MARIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
164 W HEWETT RD, SANTA ROSA BEACH, FL 32459-3310
(850) 278-3821
Mailing address
164 W HEWETT RD, SANTA ROSA BEACH, FL 32459-3310
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
22080
KS
225200000X
Physical Therapy Assistant
Primary
PTA22080
KS
Other
Enumeration date
01/30/2020
Last updated
01/30/2020
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