Healthcare Provider Details

I. General information

NPI: 1861318891
Provider Name (Legal Business Name): JOSHUA DAVID GIBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 W 20TH ST # 80634
GREELEY CO
80634-3037
US

IV. Provider business mailing address

1206 CREEKWOOD CT
WINDSOR CO
80550-5906
US

V. Phone/Fax

Practice location:
  • Phone: 970-978-5471
  • Fax:
Mailing address:
  • Phone: 970-978-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0027860
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: