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General NPI Number Information
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NPI Number | 1851872576
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Entity Type | Individual
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Provider Name | SAMUEL JOHN GILBERTSON PTA
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Gender | Male
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 2401 DEVELOPMENT BLVD
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City | BELLMEAD
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State | TX
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Zip | 76705-2903
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Country | US
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Telephone | 254-296-8987
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24043
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City | WACO
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State | TX
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Zip | 76702-4043
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Country | US
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Telephone | 254-315-7994
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2121599
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License Number State | TX
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