Healthcare Provider Details

I. General information

NPI: 1154572956
Provider Name (Legal Business Name): CHRISTOPHER L GIBBONS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10241 E APACHE TRL
APACHE JUNCTION AZ
85220-3203
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-0300
US

V. Phone/Fax

Practice location:
  • Phone: 888-201-1040
  • Fax: 866-245-8064
Mailing address:
  • Phone: 888-201-1040
  • Fax: 866-245-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8232
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: