Individual
LARRY MARLIN GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1625 HILL ST, ANDERSON, IN 46012-2425
(765) 644-1860
Mailing address
1625 HILL ST, ANDERSON, IN 46012-2425
(765) 644-1860
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004222A
IN
Other
Enumeration date
04/11/2011
Last updated
04/11/2011
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