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General NPI Number Information
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NPI Number | 1750426607
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Entity Type | Individual
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Provider Name | ERIC GIBBS MSED, LATC , CSCS
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | PLYMOUTH STATE UNIVERSITY 17 HIGH ST, MSC 32, PE CENTER
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City | PLYMOUTH
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State | NH
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Zip | 03264
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Country | US
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Telephone | 603-535-2791
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Fax |
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Provider Business Mailing Address
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Address Line | 12 TRIPPLEWOOD RD UNIT 22
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City | CAMPTON
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State | NH
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Zip | 03223-4601
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0012
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License Number State | NH
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