Provider Demographics
NPI:1790973683
Name:GIBSON, MARGARET MARY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 CORDELLA ST
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7113
Mailing Address - Country:US
Mailing Address - Phone:614-367-0692
Mailing Address - Fax:
Practice Address - Street 1:1504 W 1ST AVE STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3472
Practice Address - Country:US
Practice Address - Phone:614-485-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist