Provider Demographics
NPI:1053666339
Name:LIBBY, JOHN K (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:LIBBY
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:1190 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5063
Practice Address - Country:US
Practice Address - Phone:207-376-3000
Practice Address - Fax:207-373-3003
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2015-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME3550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002819601Medicare PIN