Provider Demographics
NPI:1649998436
Name:GIBBS, LEEANNA DANIELLE (LMBT)
Entity type:Individual
Prefix:
First Name:LEEANNA
Middle Name:DANIELLE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 S PARK WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-1235
Mailing Address - Country:US
Mailing Address - Phone:910-751-2300
Mailing Address - Fax:
Practice Address - Street 1:230 LINDSAY RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6725
Practice Address - Country:US
Practice Address - Phone:910-751-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist