Healthcare Provider Details

I. General information

NPI: 1033768403
Provider Name (Legal Business Name): JOSEPH CODY IBARRA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 MOHAWK DR
WEST HARTFORD CT
06117-2104
US

IV. Provider business mailing address

194 MOHAWK DR
WEST HARTFORD CT
06117-2104
US

V. Phone/Fax

Practice location:
  • Phone: 909-618-6855
  • Fax:
Mailing address:
  • Phone: 860-281-2441
  • Fax: 860-370-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012815
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number044432-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: