Provider Demographics
NPI:1992378954
Name:GIBSON, LISA JOYCE (LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOYCE
Last Name:GIBSON
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 1:783 ROUTE 3A
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4045
Mailing Address - Country:US
Mailing Address - Phone:603-228-7711
Mailing Address - Fax:603-228-7701
Practice Address - Street 1:783 ROUTE 3A
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-4045
Practice Address - Country:US
Practice Address - Phone:603-228-7711
Practice Address - Fax:603-228-7701
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3049M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist