Provider Demographics
NPI:1710579552
Name:GIBBS, AUSTIN DREW
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:DREW
Last Name:GIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 OLD SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3563
Mailing Address - Country:US
Mailing Address - Phone:205-810-4492
Mailing Address - Fax:
Practice Address - Street 1:5740 OLD SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3563
Practice Address - Country:US
Practice Address - Phone:205-810-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist