Gibson, Cody Robert

Gibson, Cody Robert is an individual health care provider with primary practice located at 4318 Spyres Way , Modesto CA 95356-9259. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as his primary health care specialty. Gibson, Cody Robert can be contacted via phone (209) 576-0710.

Contact Information

Primary practice address
4318 Spyres Way Modesto CA 95356-9259
Phone: (209) 576-0710
Fax: (209) 576-7283
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X

Profile Details

NPI number 1699164459
LBN Legal business name Gibson, Cody Robert
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2015
Last updated Jan 16th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699164459 NPPES
California Other ZZZ03337Z MEDICARE

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