Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 8900 | AZ |
NPI | 1184997686 |
---|---|
Provider Name | Patricia Gail Ibis |
First Address | Sherman Oaks, CA 91423-3677 |
Second Address | Scottsdale, AZ 85255-6323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |