Provider Demographics
NPI:1932642378
Name:GIBSON, JILL A (LMT, MMP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W MEADOW BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2000
Mailing Address - Country:US
Mailing Address - Phone:520-989-9246
Mailing Address - Fax:
Practice Address - Street 1:3601 W MEADOW BRIAR DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2000
Practice Address - Country:US
Practice Address - Phone:520-989-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT20783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist