Individual
MARISA GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3145 N DYSART RD STE 109, AVONDALE, AZ 85392-6802
(623) 522-8491
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(306) 575-1980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13184
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13184
LICENSE
AZ
Enumeration date
08/22/2017
Last updated
12/31/2018
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