Basic Information
| Provider Information | |||||||||
| NPI: | 1568917169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | SANDRA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2021 CHURCH ST | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152847555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2021 CHURCH ST | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152847555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2016 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT0000010824 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.