Individual
MS. SUSAN H GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1304 W BRADLEY AVE, CHAMPAIGN, IL 61821-2035
(217) 359-0287
Mailing address
123 W WILLIAM ST, MONTICELLO, IL 61856-1939
(217) 762-3914
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070003093
IL
Other
Enumeration date
04/22/2008
Last updated
04/22/2008
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