| NPI | 1457533655 |
|---|---|
| Former Name | VENILLA R GIBSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT009550) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305205271) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2017-07-07 |