Healthcare Provider Details

I. General information

NPI: 1487951943
Provider Name (Legal Business Name): SONYA GIBBS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 N ESHMAN AVE
WEST POINT MS
39773-5436
US

IV. Provider business mailing address

5543 GEORGE WALKER RD
WEST POINT MS
39773-4331
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-6011
  • Fax: 662-492-0065
Mailing address:
  • Phone: 662-494-3669
  • Fax: 662-492-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1578
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: