Provider Demographics
NPI:1134799067
Name:KIBE, AMY LYNN (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:KIBE
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 1:1032 SUMMER HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2838
Mailing Address - Country:US
Mailing Address - Phone:717-612-0320
Mailing Address - Fax:
Practice Address - Street 1:1032 SUMMER HAVEN LN
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2838
Practice Address - Country:US
Practice Address - Phone:717-612-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT125900OtherMT125900