Provider Demographics
NPI:1114192143
Name:KNIBBS, MALINDA ANN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MALINDA
Middle Name:ANN
Last Name:KNIBBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COLONIAL CIR
Mailing Address - Street 2:#2
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1468
Mailing Address - Country:US
Mailing Address - Phone:716-881-7198
Mailing Address - Fax:
Practice Address - Street 1:12 COLONIAL CIR
Practice Address - Street 2:#2
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1468
Practice Address - Country:US
Practice Address - Phone:716-881-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004983172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist