Provider Demographics
NPI:1518799774
Name:GO, CHRISTINE MAE GIBERSON (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE MAE
Middle Name:GIBERSON
Last Name:GO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 AVENUE P
Mailing Address - Street 2:APT 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1378
Mailing Address - Country:US
Mailing Address - Phone:929-689-2344
Mailing Address - Fax:
Practice Address - Street 1:1213 AVENUE P
Practice Address - Street 2:APT 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1378
Practice Address - Country:US
Practice Address - Phone:929-689-2344
Practice Address - Fax:716-339-0945
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist