Provider Demographics
NPI:1578220307
Name:GIPSON, JULIANN JERNIGAN (PT)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:JERNIGAN
Last Name:GIPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SUMMIT AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4428
Mailing Address - Country:US
Mailing Address - Phone:817-926-3330
Mailing Address - Fax:
Practice Address - Street 1:1201 SUMMIT AVE STE 500
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4428
Practice Address - Country:US
Practice Address - Phone:817-926-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056562208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation