Provider Demographics
NPI:1548654395
Name:TIBBS, ALICIA (LMT)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:
Last Name:TIBBS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5774 KINGSGATE DR APT D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-4243
Mailing Address - Country:US
Mailing Address - Phone:352-615-5046
Mailing Address - Fax:
Practice Address - Street 1:5774 KINGSGATE DR APT D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-4243
Practice Address - Country:US
Practice Address - Phone:352-615-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist