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General NPI Number Information
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NPI Number | 1811106933
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Entity Type | Individual
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Provider Name | KRISTIN RAYE GIBSON PT, CLT, ATC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 301 S BRYANT AVE BLDG. B-100
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City | EDMOND
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State | OK
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Zip | 73034-5790
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Country | US
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Telephone | 405-340-2019
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Fax | 405-340-4635
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Provider Business Mailing Address
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Address Line | 416 HERITAGE BLVD
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City | EDMOND
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State | OK
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Zip | 73003-2764
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Country | US
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Telephone | 405-340-2019
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Fax | 405-340-4635
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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 | 1487
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 83
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License Number State | OK
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