Individual
MR. MARK H GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, PT
Contact information
Practice address
1725 STATE ST, UNIV. OF WISCONSIN - LA CROSSE, LA CROSSE, WI 54601-3742
(608) 785-8190
Mailing address
4825 SILVER MORNING LN, LA CROSSE, WI 54601-2283
(608) 788-3972
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4707-024
WI
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
404-039
WI
Other
Enumeration date
11/16/2006
Last updated
06/17/2008
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