Provider Demographics
NPI:1023106366
Name:TIBBE, MARIA C (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:TIBBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WEEKS AVE
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2044
Mailing Address - Country:US
Mailing Address - Phone:516-903-4563
Mailing Address - Fax:631-775-0142
Practice Address - Street 1:3400 BRUSH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1712
Practice Address - Country:US
Practice Address - Phone:516-903-4563
Practice Address - Fax:631-775-0142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0157421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q47284Medicare UPIN
NYQ22D11Medicare ID - Type Unspecified