Provider Demographics
NPI:1528548278
Name:KIBLER, LYNETTE COULOMBE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:COULOMBE
Last Name:KIBLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04969-3168
Mailing Address - Country:US
Mailing Address - Phone:207-341-6992
Mailing Address - Fax:
Practice Address - Street 1:361 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04969-3168
Practice Address - Country:US
Practice Address - Phone:207-341-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist