Provider Demographics
NPI:1831598168
Name:GIBSON, HEATHER (DPT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:SUITE A265
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:623-374-2424
Mailing Address - Fax:623-374-2619
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:SUITE A265
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:623-374-2424
Practice Address - Fax:623-374-2619
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist