Individual
KENNETH GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, NCMMT
Contact information
Practice address
1901 BRINSON RD, UNIT P-2, LUTZ, FL 33558-5176
(813) 949-6256
Mailing address
1901 BRINSON RD, UNIT P-2, LUTZ, FL 33558-5176
(813) 949-6256
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA28530
FL
Other
Enumeration date
11/13/2007
Last updated
11/13/2007
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