Provider Demographics
NPI:1952868580
Name:GIBSON, KATIE (MSAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MSAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 E SWENSON AVE
Mailing Address - Street 2:
Mailing Address - City:ASPERMONT
Mailing Address - State:TX
Mailing Address - Zip Code:79502-2044
Mailing Address - Country:US
Mailing Address - Phone:940-200-1042
Mailing Address - Fax:
Practice Address - Street 1:928 E SWENSON AVE
Practice Address - Street 2:
Practice Address - City:ASPERMONT
Practice Address - State:TX
Practice Address - Zip Code:79502-2044
Practice Address - Country:US
Practice Address - Phone:940-200-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT74502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer