Individual
MRS. KORTNIE BRYANNE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1111 EUCLID AVE, CAMERON, MO 64429-2005
(660) 632-6010
Mailing address
PO BOX 383, WARSAW, MO 65355-0383
(660) 438-6993
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2008035475
MO
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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