Healthcare Provider Details

I. General information

NPI: 1194587014
Provider Name (Legal Business Name): VIRGINIA GIBBS MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S DOWNING ST
DENVER CO
80210-5847
US

IV. Provider business mailing address

2535 S DOWNING ST
DENVER CO
80210-5847
US

V. Phone/Fax

Practice location:
  • Phone: 720-726-7995
  • Fax:
Mailing address:
  • Phone: 720-726-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0002607
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: