MEDICARE: MS. CHRISTINE MAE GIBERSON GO P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	051753	NY

General Provider Information

NPI Number	:	1518799774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE MAE GIBERSON GO P.T.

Provider Business Mailing Address
First Line	:	1213 AVENUE P
Second Line	:	APT 2F
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1378
Country	:	US
Telephone Number	:	929-689-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 AVENUE P
Second Line	:	APT 2F
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1378
Country	:	US
Telephone Number	:	929-689-2344
Fax Number	:	716-339-0945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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