Provider Demographics
NPI:1528377918
Name:GIBSON, JUDITH LOUISE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LOUISE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 VICKERY AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443-2026
Mailing Address - Country:US
Mailing Address - Phone:253-926-8396
Mailing Address - Fax:
Practice Address - Street 1:5125 VICKERY AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98443-2026
Practice Address - Country:US
Practice Address - Phone:253-926-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-02
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60126583172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist