Provider Demographics
NPI:1306464532
Name:ALLEN-GIBBS, JOANNA II
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:ALLEN-GIBBS
Suffix:II
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 1:6340 NAKIA DR
Mailing Address - Street 2:
Mailing Address - City:REMBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29128-8820
Mailing Address - Country:US
Mailing Address - Phone:803-464-1607
Mailing Address - Fax:
Practice Address - Street 1:6340 NAKIA DR
Practice Address - Street 2:
Practice Address - City:REMBERT
Practice Address - State:SC
Practice Address - Zip Code:29128-8820
Practice Address - Country:US
Practice Address - Phone:803-464-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist