Basic Information
| Provider Information | |||||||||
| NPI: | 1831238344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4275 OLD NEW ENGLAND RD | ||||||||
| Address2: | |||||||||
| City: | ALLISON PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151011533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124873283 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 FREEPORT RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152153301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127845010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-003109-L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.