Provider Demographics
NPI:1275735714
Name:GIBSON, RICHARD JAY (LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAY
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-3509
Mailing Address - Country:US
Mailing Address - Phone:828-837-8080
Mailing Address - Fax:
Practice Address - Street 1:429 HILL ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3509
Practice Address - Country:US
Practice Address - Phone:828-837-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist