Provider Demographics
NPI:1295376739
Name:GIBSON, EVA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EVA
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 1:4140 FERNCREEK DR STE 801
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2572
Mailing Address - Country:US
Mailing Address - Phone:910-484-2171
Mailing Address - Fax:910-484-4568
Practice Address - Street 1:4140 FERNCREEK DR STE 801
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2572
Practice Address - Country:US
Practice Address - Phone:910-484-2171
Practice Address - Fax:910-484-4568
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12520225100000X
MOCP000676T225100000X
NCCP-CP024275T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist