Provider Demographics
NPI:1568446771
Name:MAYCOCK GIBSON, NARIBA (DPT)
Entity Type:Individual
Prefix:
First Name:NARIBA
Middle Name:
Last Name:MAYCOCK GIBSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:812-590-8333
Practice Address - Street 1:33492 OAK GLEN RD STE H
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2096
Practice Address - Country:US
Practice Address - Phone:909-797-5155
Practice Address - Fax:909-797-2768
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT269970OtherMEDICARE PTAN
WA0206908OtherWA DEPT OF LABOR
CAP64637Medicare UPIN