Provider Demographics
NPI:1487998753
Name:TWIBEY, J ADELLE (PT)
Entity type:Individual
Prefix:
First Name:J
Middle Name:ADELLE
Last Name:TWIBEY
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 1:3875 S 4950 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6829
Mailing Address - Country:US
Mailing Address - Phone:801-821-7569
Mailing Address - Fax:
Practice Address - Street 1:3875 S 4950 W
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6829
Practice Address - Country:US
Practice Address - Phone:801-821-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT116591-2401225100000X
IDPT-559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist