Provider Demographics
NPI:1043350291
Name:GIBSON, WILLIAM BAYS (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BAYS
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 APPERSON DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7235
Mailing Address - Country:US
Mailing Address - Phone:540-772-8022
Mailing Address - Fax:540-527-0055
Practice Address - Street 1:2119 APPERSON DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7235
Practice Address - Country:US
Practice Address - Phone:540-772-8022
Practice Address - Fax:540-527-0055
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA193442OtherANTHEM PT LOC 5
VA193431OtherANTHEM PT LOC 1
VA249624OtherANTHEM PT LOC 6
VA193434OtherANTHEM PT LOC 2
VA193437OtherANTHEM PT LOC 3
VA193434OtherANTHEM PT LOC 2
VA009980L23Medicare ID - Type Unspecified