Provider Demographics
NPI:1083330260
Name:HIBBERT, AMARA (LMT)
Entity Type:Individual
Prefix:
First Name:AMARA
Middle Name:
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMARA
Other - Middle Name:
Other - Last Name:HIBBERT-DIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3101 PORT ROYALE BLVD APT 1133
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7825
Mailing Address - Country:US
Mailing Address - Phone:929-293-9203
Mailing Address - Fax:
Practice Address - Street 1:3101 PORT ROYALE BLVD APT 1133
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7825
Practice Address - Country:US
Practice Address - Phone:929-293-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist