Provider Demographics
NPI:1093237323
Name:GIBBS, KATHRYN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:522 N CENTER ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3695
Practice Address - Country:US
Practice Address - Phone:706-646-4371
Practice Address - Fax:706-646-4372
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT8513225100000X
GAPT012775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist