Provider Demographics
NPI:1710690714
Name:GIBSON, BRITTNEY KRISTINE
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:KRISTINE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 FAIRGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-6067
Mailing Address - Country:US
Mailing Address - Phone:832-538-3696
Mailing Address - Fax:
Practice Address - Street 1:201 E 118TH ST APT 5C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4180
Practice Address - Country:US
Practice Address - Phone:832-538-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002699225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist