Trent Conner Gibson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2015024305 Issued in MO

Practice address

1 Meramec Bluffs Dr
Ballwin, MO 63021-3309

Phone

(636) 861-0600

NPI assigned

Nov 24, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1538826581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4841 COLONY CHURCH RD APT 3",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631291151",
            "telephone_number": "314-262-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERAMEC BLUFFS DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630213309",
            "telephone_number": "636-861-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "TRENT",
        "middle_name": "CONNER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-24",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2015024305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gateway Little Smiles of Ballwin, LLC
• Seth Gerlach, D.C.
• Cole Gerstenberger, DPT
• Lynne Gibbs, D.C.
• McKenzie Gibson, RBT
• Jennifer Sharon Giltner, FNP-C
• Ashleigh Ann Glass, PA-C
• Emmalene Faith Glover, DC
• Bradley Gloyeske, DC
• Sara Goede, LCSW

• Physical Therapy Assistant in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.