Individual
GABE E MCKIBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2904 WALNUT AVE, MATTOON, IL 61938-4942
(217) 254-5118
Mailing address
2904 WALNUT AVE, MATTOON, IL 61938-4942
(217) 254-5118
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.009243
IL
Other
Enumeration date
01/07/2022
Last updated
01/07/2022
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