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General NPI Number Information
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NPI Number | 1548845878
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Entity Type | Individual
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Provider Name | KATE DIBBIN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 704 S ILLINOIS ST
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City | GENESEO
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State | IL
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Zip | 61254-1782
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Country | US
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Telephone | 847-528-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 51ST AVE
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City | MOLINE
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State | IL
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Zip | 61265-7553
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Country | US
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Telephone | 478-528-3342
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070018182
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License Number State | IL
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