Individual ProviderMark H GibsonPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1725 State St, Univ. Of Wisconsin - La Crosse, La Crosse, WI 54601-3742(608) 785-8190(608) 788-3972PECOS EnrollmentBased on the most recent information from CMS, provider Mark H Gibson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1679646749Provider TypeIndividualFull NameGibson, Mark HTitleMr.CredentialLAT, PTGenderMaleSole ProprietorYesEnumeration Date11/16/2006Last Updated6/17/2008Contact InformationPractice LocationPractice Address1725 State St, Univ. Of Wisconsin - La Crosse, La Crosse, WI 54601-3742Phone(608) 785-8190FaxUnlisted FaxMailing LocationMailing Address4825 Silver Morning Ln, La Crosse, WI 54601-2283Phone(608) 788-3972FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense4707-024WisconsinCode225500000XDescriptionSpecialist/TechnologistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense404-039Wisconsin