Individual
MR. MATTHEW GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
W229N1416 WESTWOOD DR STE 4, WAUKESHA, WI 53186-1309
(262) 349-9297
(262) 278-4062
Mailing address
W229N1416 WESTWOOD DR STE 4, WAUKESHA, WI 53186-1309
(262) 349-9297
(262) 278-4062
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10389-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40455400
—
WI
01
—
P00231054
RAILROAD MEDICARE IND #
WI
Enumeration date
11/14/2005
Last updated
03/25/2021
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