Provider Demographics
NPI:1770071805
Name:GIBSON, TAYLOR DAWN POWELL
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DAWN POWELL
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 RENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-6500
Mailing Address - Country:US
Mailing Address - Phone:205-907-5166
Mailing Address - Fax:
Practice Address - Street 1:420 DEAN DR
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2763
Practice Address - Country:US
Practice Address - Phone:205-631-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant