Healthcare Provider Details

I. General information

NPI: 1134799257
Provider Name (Legal Business Name): DAWN MARIE GIBSON LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE DORKO

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 SW KIRKLAWN AVE
TOPEKA KS
66609-1257
US

IV. Provider business mailing address

3120 SW BRIARWOOD CIR
TOPEKA KS
66611-1810
US

V. Phone/Fax

Practice location:
  • Phone: 785-260-4745
  • Fax:
Mailing address:
  • Phone: 817-863-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT8676
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01822
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: