Doctor Name: | TARA C GIBSON |
NPI Number: | 1982954038 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPT |
License Number: | 034115 |
Business Practice Address: | 1445 E Putnam Ave 2nd Floor Old Greenwich, CT - 068701379 |
Business Phone Number: | 2039835748 |
Business Fax Number: | |
Mailing Address: | 126 Hollow Wood Ln, GREENWICH |
State: | CT |
Postal Code: | 068315019 |
Phone Number: | 9178041020 |
Fax Number: | |
NPI Enumeration Date: | 09/17/2012 |
NPI Last Update Date: | 09/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 034115 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |