Provider Demographics
NPI:1114469434
Name:GIBSON, ANN MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 PARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2562
Mailing Address - Country:US
Mailing Address - Phone:732-494-0895
Mailing Address - Fax:732-494-0896
Practice Address - Street 1:1000 GALLOPING HILL RD
Practice Address - Street 2:SUITE 201B
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7989
Practice Address - Country:US
Practice Address - Phone:908-258-8782
Practice Address - Fax:908-258-8783
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01693400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist