Healthcare Provider Details

I. General information

NPI: 1811547888
Provider Name (Legal Business Name): BIANCA TIBERI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 SCARSDALE AVE
SCARSDALE NY
10583-5318
US

IV. Provider business mailing address

425 SHERMAN AVE APT B2
PEEKSKILL NY
10566-5649
US

V. Phone/Fax

Practice location:
  • Phone: 914-722-9200
  • Fax:
Mailing address:
  • Phone: 401-864-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number044964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: