MEDICARE: MR. ANTHONY GIBBS

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	225200000X	Physical Therapy Assistant	PTA867
2	225200000X	Physical Therapy Assistant	PTA867	AR

General Provider Information

NPI Number	:	1891519039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY GIBBS

Provider Business Mailing Address
First Line	:	3016 N HILLS BLVD APT 8113
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-9456
Country	:	US
Telephone Number	:	501-831-9227
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 N HILLS BLVD APT 8113
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-9456
Country	:	US
Telephone Number	:	501-831-9227
Fax Number	:

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

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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Directions to “ MR. ANTHONY GIBBS ” Practice Location

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