Individual
MR. MICHAEL RYAN GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
122 SANDSTONE DR APT 12, BECKLEY, WV 25801-2843
(304) 923-2427
Mailing address
122 SANDSTONE DR APT 12, BECKLEY, WV 25801-2843
(304) 923-2427
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001632
WV
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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