Provider Demographics
NPI:1265821029
Name:GIBSON, SARA PHELPS (PT,MPT)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:PHELPS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PT,MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 ALEXIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1958
Mailing Address - Country:US
Mailing Address - Phone:423-886-0338
Mailing Address - Fax:
Practice Address - Street 1:671 ALEXIAN WAY
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-1958
Practice Address - Country:US
Practice Address - Phone:423-886-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000010292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist