Provider Demographics
NPI:1083000129
Name:GIBSON, NADINE (DPT)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:ERNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1257 W WARNER RD
Mailing Address - Street 2:STE A-2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2713
Mailing Address - Country:US
Mailing Address - Phone:480-821-2286
Mailing Address - Fax:
Practice Address - Street 1:6824 E BROWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3705
Practice Address - Country:US
Practice Address - Phone:480-924-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ104992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic