Individual
ADAM GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(765) 206-1042
Mailing address
8500 S 100 W, FAIRMOUNT, IN 46928-9228
(765) 206-1042
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002944A
IN
Other
Enumeration date
03/09/2018
Last updated
03/09/2018
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