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NPI Code Detail

MEDICARE: NATHAN GIBBONS DPT

MEDICARE: NATHAN GIBBONS DPT
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
1225100000XPhysical TherapistPTL89432MA

General Provider Information

NPI Number : 1720920002
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN GIBBONS DPT
Provider Business Mailing Address
First Line : 4 RICHMOND SQ
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-5117
Country : US
Telephone Number : 401-433-4172
Fax Number : 401-433-0612
Provider Business Practice Location Address
First Line : 275 FOREST RIDGE RD
Second Line :
City : CONCORD
State : MA
Zip : 01742-3830
Country : US
Telephone Number : 978-254-5313
Fax Number : 833-291-4581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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