Provider Demographics
NPI:1003531187
Name:LIGIBEL, THOMAS EDWARD
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:LIGIBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5765
Mailing Address - Country:US
Mailing Address - Phone:618-558-3745
Mailing Address - Fax:
Practice Address - Street 1:379 FOUNTAINS PKWY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2044
Practice Address - Country:US
Practice Address - Phone:618-624-9940
Practice Address - Fax:618-624-9945
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005085225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant