Individual
EVAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
131 ROUTE 70, MEDFORD, NJ 08055-9501
(856) 533-0920
(856) 375-1110
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(631) 580-5200
(631) 760-8306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01933400
NY
225100000X
Physical Therapist
PT-6973
ID
Other
Enumeration date
07/14/2020
Last updated
08/07/2020
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