Provider Demographics
NPI:1447491873
Name:GIBSON, KIMBERLY (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 SLIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3901
Mailing Address - Country:US
Mailing Address - Phone:407-649-6888
Mailing Address - Fax:407-246-0135
Practice Address - Street 1:1301 SLIGH BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3901
Practice Address - Country:US
Practice Address - Phone:407-649-6888
Practice Address - Fax:407-246-0135
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000698400Medicaid