Individual
MR. MICHAEL CHARLES GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2480 LIBERTY ST NE, SALEM, OR 97303-6780
(503) 763-3525
(503) 763-3526
Mailing address
FILE 50469, LOS ANGELES, CA 90074-0469
(530) 778-0200
(530) 778-0200
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
0979
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227892
—
OR
01
—
5467820001
MEDICARE DME NUMBER
OR
Enumeration date
11/08/2005
Last updated
03/20/2013
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