Individual
TRENT CONNER GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MERAMEC BLUFFS DR, BALLWIN, MO 63021-3309
(636) 861-0600
Mailing address
4841 COLONY CHURCH RD APT 3, SAINT LOUIS, MO 63129-1151
(314) 262-0312
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2015024305
MO
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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