Provider Demographics
NPI:1285073726
Name:GIBSON, KRISTIE LYNN (LMTP,CMA,CMT)
Entity type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMTP,CMA,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23980 CHAGRIN BLVD
Mailing Address - Street 2:SUITE #203, 2ND FLOOR
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5548
Mailing Address - Country:US
Mailing Address - Phone:216-832-7800
Mailing Address - Fax:216-274-9335
Practice Address - Street 1:23980 CHAGRIN BLVD
Practice Address - Street 2:SUITE #203, 2ND FLOOR
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5548
Practice Address - Country:US
Practice Address - Phone:216-832-7800
Practice Address - Fax:216-274-9335
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-019973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist