Provider Demographics
NPI:1740376771
Name:GIBSON, JOYCE IRENE (MA, PT)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:IRENE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 POWDER HORN CT.
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1825
Mailing Address - Country:US
Mailing Address - Phone:732-671-5572
Mailing Address - Fax:
Practice Address - Street 1:10 POWDER HORN CT.
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1825
Practice Address - Country:US
Practice Address - Phone:732-671-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00292600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist