Provider Demographics
NPI:1386852994
Name:GIBBINS, DOUG W (LAT,ATC)
Entity Type:Individual
Prefix:MR
First Name:DOUG
Middle Name:W
Last Name:GIBBINS
Suffix:
Gender:M
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 BROWNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4361
Mailing Address - Country:US
Mailing Address - Phone:214-695-3964
Mailing Address - Fax:
Practice Address - Street 1:4233 GRASSMERE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1040
Practice Address - Country:US
Practice Address - Phone:214-780-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT02572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer