MEDICARE: ANGELA TIBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	38944	CA

General Provider Information

NPI Number	:	1528408242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA TIBBS

Provider Business Mailing Address
First Line	:	14026 VALLEY SPRINGS RD
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-1445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 W CHANSLOR WAY
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1246
Country	:	US
Telephone Number	:	760-922-8176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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Directions to “ ANGELA TIBBS ” Practice Location

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