Doctor Name: | MR. MARK H GIBSON |
NPI Number: | 1679646749 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LAT, PT |
License Number: | 404-039 |
Business Practice Address: | 1725 State St Univ. Of Wisconsin - La Crosse La Crosse, WI - 546013742 |
Business Phone Number: | 6087858190 |
Business Fax Number: | |
Mailing Address: | 4825 Silver Morning Ln, LA CROSSE |
State: | WI |
Postal Code: | 546012283 |
Phone Number: | 6087883972 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 06/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225500000X |
License Number: | 404-039 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Specialist/Technologist |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |