Provider Demographics
NPI:1952544314
Name:GIBBONS, LAURA A (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:IDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:122 BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1822
Mailing Address - Country:US
Mailing Address - Phone:908-627-3033
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:122 BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1822
Practice Address - Country:US
Practice Address - Phone:908-627-3033
Practice Address - Fax:631-580-5222
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01287100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist