Active NPI
Kallie Rae Gibson, PT
- Physical Therapist
- Macclenny, FL
National Provider Identifier
1104451764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT34368
- Practice address
- 534 S 5TH St
Macclenny, FL 32063-2602 - Phone
- (904) 259-1649
- NPI assigned
- Mar 4, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT34368 | FL | Primary |
Addresses
Primary practice location
534 S 5TH St
Macclenny, FL 32063-2602
Mailing address
PO Box 8847
Fleming Island, FL 32006-0019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583280000000",
"number": "1104451764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8847",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320060019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "534 S 5TH ST",
"city": "MACCLENNY",
"state": "FL",
"postal_code": "320632602",
"telephone_number": "904-259-1649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "KALLIE",
"middle_name": "RAE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-04",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT34368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macclenny, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.