Provider Demographics
NPI:1013294487
Name:GIBSON, ELIZABETH HOLDEN (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HOLDEN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LUTHER LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-4921
Mailing Address - Country:US
Mailing Address - Phone:864-903-4090
Mailing Address - Fax:
Practice Address - Street 1:311 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2157
Practice Address - Country:US
Practice Address - Phone:864-261-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist