Provider Demographics
NPI:1447292651
Name:GIBBONS, THMOAS (MA CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:THMOAS
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12012 LAKE CYPRESS CIR C302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-619-7548
Mailing Address - Fax:
Practice Address - Street 1:12424 RESEARCH PARKWAY SUIT 155
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:DC
Practice Address - Zip Code:32826
Practice Address - Country:US
Practice Address - Phone:407-249-4774
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist