Provider Demographics
NPI:1508223249
Name:IBARRA, LILIA (PT)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SOSCOL AVE
Mailing Address - Street 2:SUITE B 191
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-4036
Mailing Address - Country:US
Mailing Address - Phone:707-224-3131
Mailing Address - Fax:707-224-2356
Practice Address - Street 1:433 SOSCOL AVE
Practice Address - Street 2:SUITE B 191
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4036
Practice Address - Country:US
Practice Address - Phone:707-224-3131
Practice Address - Fax:707-224-2356
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist