MEDICARE: SYDNEY M GIBSON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1215595848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY M GIBSON LMT

Provider Business Mailing Address
First Line	:	143 W KELLOGG RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8009
Country	:	US
Telephone Number	:	360-746-6679
Fax Number	:	360-746-6014

Provider Business Practice Location Address
First Line	:	143 W KELLOGG RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8009
Country	:	US
Telephone Number	:	360-746-6679
Fax Number	:	360-746-6014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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