Provider Demographics
NPI:1609192392
Name:GIBSON, EARTHA (LMT)
Entity Type:Individual
Prefix:
First Name:EARTHA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 STONECREST CT
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8155
Mailing Address - Country:US
Mailing Address - Phone:502-647-4600
Mailing Address - Fax:
Practice Address - Street 1:60 STONECREST CT
Practice Address - Street 2:SUITE 140
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8155
Practice Address - Country:US
Practice Address - Phone:502-647-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist