Provider Demographics
NPI:1699087049
Name:BLUE, GIBI (LRCP)
Entity type:Individual
Prefix:
First Name:GIBI
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:LRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2312
Mailing Address - Country:US
Mailing Address - Phone:501-219-1829
Mailing Address - Fax:501-223-3180
Practice Address - Street 1:8625 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2312
Practice Address - Country:US
Practice Address - Phone:501-219-1829
Practice Address - Fax:501-223-3180
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRCP-19672278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation