Individual provider Active NPI

Kentron Markese Gibson, DPT

  • Physical Therapist
  • Tupelo, MS
National Provider Identifier
1669266904
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8067 Issued in MS
Practice address
1211 S Gloster St Ste C
Tupelo, MS 38801-6548
Phone
(662) 432-1523
NPI assigned
Apr 9, 2025
Last updated
Aug 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12002R LA
Physical Therapist 225100000X 8067 MS Primary

Addresses

Primary practice location

1211 S Gloster St Ste C
Tupelo, MS 38801-6548

Mailing address

1211 S Gloster St Ste C
Tupelo, MS 38801-6548
Phone (662) 432-1523

Other practice location 1

1001 School St
Houma, LA 70360-4629
Phone (985) 868-1540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250829000512 MS Practitioner - Physical Therapist in Private Practice 7810413390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sog Physical TherapyGroup PAC ID 1850627209, 20 clinicians

Practice addresses (Care Compare)

1211 S Gloster St
Suite C
Tupelo, MS 38801-6548
Phone (662) 432-1523

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12002RLAMDPhysical Therapist
8067MSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Houma Orthopedic Clinic AMC CurrentSince Apr 21, 2025 Accepting new patients
Houma Orthopedic Clinic AMC CurrentSince Apr 21, 2025 Accepting new patients
Sog Physical Therapy Physical Therapist CurrentSince Aug 15, 2025 Accepting new patients
Specialty Orthopedic Group of Ms, PLLC PastSince Aug 15, 2025 Accepting new patients

Locations

1945 Scottsville Rd
Ste B2
Bowling Green, KY 42104
Phone (270) 781-4828

1001 School St
Houma, LA 70360
Phone (504) 868-1540

1340 Elm St
Ste 200
Morgan City, LA 70380
Phone (985) 868-1540

199 N Brookmoore Dr
Columbus, MS 39705
Phone (662) 798-0108

118 Highway 12 W
Ste 1
Starkville, MS 39759
Phone (662) 432-1523

1211 S Gloster St
Ste C
Tupelo, MS 38801
Phone (662) 432-1523

Networks

  • Freedom Health HMO Network

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1744156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1669266904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST STE C",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016548",
            "telephone_number": "662-432-1523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST STE C",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016548",
            "telephone_number": "662-432-1523"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 School St",
            "address_purpose": "LOCATION",
            "city": "Houma",
            "state": "LA",
            "postal_code": "703604629",
            "country_code": "US",
            "telephone_number": "985-868-1540",
            "fax_number": "985-876-0759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KENTRON",
        "middle_name": "MARKESE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-09",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "12002R",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "8067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.