MEDICARE: MRS. MUAREEN ELIZABETH GIBSON MSPT

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	PT012541L	PA

General Provider Information

NPI Number	:	1932349495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MUAREEN ELIZABETH GIBSON MSPT

Provider Business Mailing Address
First Line	:	6249 MONTAGUE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3505
Country	:	US
Telephone Number	:	215-332-7944
Fax Number	:

Provider Business Practice Location Address
First Line	:	2869 HOLME AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2118
Country	:	US
Telephone Number	:	215-676-4070
Fax Number	:	215-676-4071

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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