Provider Demographics
NPI:1689164402
Name:STIBB, JOSHUA GEORGE (PT, DPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:GEORGE
Last Name:STIBB
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W10437 COUNTY ROAD G
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-9552
Mailing Address - Country:US
Mailing Address - Phone:920-319-2396
Mailing Address - Fax:
Practice Address - Street 1:1812 N LAKEWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2635
Practice Address - Country:US
Practice Address - Phone:208-966-4475
Practice Address - Fax:208-966-4476
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
IDPT-8264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer