Provider Demographics
NPI:1417319989
Name:HIBNER, ROBERT JOHN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:HIBNER
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 1:4390 BUSCHOR ROAD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828
Mailing Address - Country:US
Mailing Address - Phone:419-305-3031
Mailing Address - Fax:419-678-4200
Practice Address - Street 1:4390 BUSCHOR RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-9705
Practice Address - Country:US
Practice Address - Phone:419-305-3031
Practice Address - Fax:419-678-4200
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2412225100000X
IN05008406A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist