Provider Demographics
NPI:1033856372
Name:GILBERTSON, MATTHEW CURTIS (ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CURTIS
Last Name:GILBERTSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2870
Mailing Address - Country:US
Mailing Address - Phone:530-514-6628
Mailing Address - Fax:
Practice Address - Street 1:500 COLLEGE HL
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1896
Practice Address - Country:US
Practice Address - Phone:530-514-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140251942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer