Provider Demographics
NPI:1245423649
Name:STANHIBEL, SCOTT (ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:STANHIBEL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E BROADWAY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1599
Mailing Address - Country:US
Mailing Address - Phone:480-829-0217
Mailing Address - Fax:480-829-1410
Practice Address - Street 1:1025 E BROADWAY RD
Practice Address - Street 2:STE 100
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1599
Practice Address - Country:US
Practice Address - Phone:480-829-0217
Practice Address - Fax:480-829-1410
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare UPIN