Matthew Jerrid Gibson, PTA
Individual provider Active NPI Physical Therapy Assistant · Irondale, AL
NPI 1669913737 · NPPES record last updated Mar 9, 2017
Key facts
- NPI
- 1669913737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 5561 (MS)
- Practice address
- 190 Cane Hedge Rd
Irondale, AL 35210-3524 - Phone
- (662) 571-0093
- NPI assigned
- Mar 9, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5561 | MS | MD | Physical Therapy Assistant |
| 2117001 | TX | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5561 | MS | Yes |
| Physical Therapy Assistant | 225200000X | 2117001 | TX |
Addresses
Primary practice location
190 Cane Hedge Rd
Irondale, AL 35210-3524
Mailing address
190 Cane Hedge Rd
Irondale, AL 35210-3524
Phone (662) 571-0093
Other providers in Irondale, AL
- Joseph Fulton
- Karen Joy Fulton
- Kayla Gaines
- Ashley Joiner Gamble
- Michael Dale Gary
- Sarah Gilbert
- Courtney Simpson Gilliland
- Grandview Surgery LLC
- Grants Mill Family Dentistry, LLC
- Kamya Graves
All providers in Irondale, AL · Physical Therapy Assistant in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.