Provider Demographics
NPI:1609221613
Name:GIBBNER, KATINA
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:GIBBNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SCHELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15559-9106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2316 VALLEY RD
Practice Address - Street 2:
Practice Address - City:SCHELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:15559-9106
Practice Address - Country:US
Practice Address - Phone:814-839-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001951A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer