Provider Demographics
NPI:1033575493
Name:HIBBS, JENNETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNETTE
Middle Name:
Last Name:HIBBS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNE
Other - Middle Name:
Other - Last Name:HIBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:800 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2155
Mailing Address - Country:US
Mailing Address - Phone:870-405-0742
Mailing Address - Fax:
Practice Address - Street 1:2900 CHARLEVOIX DR SE
Practice Address - Street 2:STE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7085
Practice Address - Country:US
Practice Address - Phone:888-325-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist