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NPI Code Detail

MEDICARE: MARK KENNETH STIBLEY PHYSICAL THERAPIST

MEDICARE: MARK KENNETH STIBLEY PHYSICAL THERAPIST
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
1225100000XPhysical TherapistPT-011519OH

General Provider Information

NPI Number : 1538285630
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK KENNETH STIBLEY PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 3715 MEADOW GTWY
Second Line :
City : BROADVIEW HEIGHTS
State : OH
Zip : 44147-2740
Country : US
Telephone Number : 440-546-4948
Fax Number :
Provider Business Practice Location Address
First Line : 6455 PEARL RD
Second Line :
City : PARMA HEIGHTS
State : OH
Zip : 44130-2984
Country : US
Telephone Number : 440-887-6293
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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