MEDICARE: LILIA IBARRA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	17892	CA

General Provider Information

NPI Number	:	1508223249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIA IBARRA PT

Provider Business Mailing Address
First Line	:	433 SOSCOL AVE
Second Line	:	SUITE B 191
City	:	NAPA
State	:	CA
Zip	:	94559-4036
Country	:	US
Telephone Number	:	707-224-3131
Fax Number	:	707-224-2356

Provider Business Practice Location Address
First Line	:	433 SOSCOL AVE
Second Line	:	SUITE B 191
City	:	NAPA
State	:	CA
Zip	:	94559-4036
Country	:	US
Telephone Number	:	707-224-3131
Fax Number	:	707-224-2356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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Directions to “ LILIA IBARRA PT” Practice Location

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