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General NPI Number Information
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NPI Number | 1205936796
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Entity Type | Individual
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Provider Name | SAMUEL MARLIN GIBSON PT
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 610 N 8TH ST SUITE 6
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City | GUNTER
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State | TX
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Zip | 75058-3586
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Country | US
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Telephone | 903-433-1401
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Fax | 903-433-1398
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | GUNTER
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State | TX
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Zip | 75058-0247
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Country | US
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Telephone | 903-433-1401
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Fax | 903-433-1398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1132587
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License Number State | TX
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