Provider Demographics
NPI:1194084566
Name:HIBBS, BECKY L (LMT)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:HIBBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12514 SE 7TH ST APT A7
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4088
Mailing Address - Country:US
Mailing Address - Phone:360-904-0607
Mailing Address - Fax:360-994-7732
Practice Address - Street 1:120 NE 117TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5020
Practice Address - Country:US
Practice Address - Phone:360-944-6692
Practice Address - Fax:360-944-7732
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00025317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist