Healthcare Provider Details

I. General information

NPI: 1720681620
Provider Name (Legal Business Name): GENEVIEVE TIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 GARDEN CREEK CIR
LOUISVILLE KY
40223-5589
US

IV. Provider business mailing address

227 BROWNS LN
LOUISVILLE KY
40207-3215
US

V. Phone/Fax

Practice location:
  • Phone: 502-541-8964
  • Fax:
Mailing address:
  • Phone: 502-893-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006683
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: