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General NPI Number Information
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NPI Number | 1225544018
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Entity Type | Individual
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Provider Name | MICHAEL R BIBBO MS, LAT, ATC, CES
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Gender | Male
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Dates
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Enumeration Date | 12/16/2017
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Last Update Date | 12/16/2017
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Provider Practice Location Address
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Address Line | 2450 N 54TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1309
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Country | US
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Telephone | 610-517-9043
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Fax |
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Provider Business Mailing Address
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Address Line | 518 SPRING MILL AVE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1950
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Country | US
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Telephone | 610-517-9043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RTO000092
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License Number State | PA
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