MEDICARE: THAIS CRISTINA GIBBY RD

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	133V00000X	Registered Dietitian	DT88187	TX

General Provider Information

NPI Number	:	1235820341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAIS CRISTINA GIBBY RD

Provider Business Mailing Address
First Line	:	8004 MANITOU SPRINGS CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-2988
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8004 MANITOU SPRINGS CT
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78717-2988
Country	:	US
Telephone Number	:	512-672-9216
Fax Number	:

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

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	05/18/2023

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