Provider Demographics
NPI:1023330719
Name:WRIGHT-GIBSON, SANDRA KAY (MPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:WRIGHT-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 1:42610 YOSEMITE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9656
Mailing Address - Country:US
Mailing Address - Phone:559-285-2525
Mailing Address - Fax:
Practice Address - Street 1:117 W DUNHAM ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5468
Practice Address - Country:US
Practice Address - Phone:559-674-0915
Practice Address - Fax:559-661-1228
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist