MEDICARE: LISA JOYCE 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	3049M	NH

General Provider Information

NPI Number	:	1992378954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JOYCE GIBSON LMT

Provider Business Mailing Address
First Line	:	783 ROUTE 3A
Second Line	:
City	:	BOW
State	:	NH
Zip	:	03304-4045
Country	:	US
Telephone Number	:	603-228-7711
Fax Number	:	603-228-7701

Provider Business Practice Location Address
First Line	:	783 ROUTE 3A
Second Line	:
City	:	BOW
State	:	NH
Zip	:	03304-4045
Country	:	US
Telephone Number	:	603-228-7711
Fax Number	:	603-228-7701

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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