Provider Demographics
NPI:1225735418
Name:GIBSON, LAUREL ALLISON (ATC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ALLISON
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:LAUREL
Other - Middle Name:ALLISON
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:2126 WYNDAMERE LN
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2154
Mailing Address - Country:US
Mailing Address - Phone:859-707-0128
Mailing Address - Fax:
Practice Address - Street 1:304 W 7TH ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1439
Practice Address - Country:US
Practice Address - Phone:859-987-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer