Provider Demographics
NPI:1053198945
Name:GIBSON, KELSEY ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 RAINBOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9061
Mailing Address - Country:US
Mailing Address - Phone:330-204-5509
Mailing Address - Fax:
Practice Address - Street 1:1100 E STATE ST
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-1536
Practice Address - Country:US
Practice Address - Phone:740-498-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH017441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist