Provider Demographics
NPI:1790921054
Name:HIBSHMAN, FAYE L (PTA)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:L
Last Name:HIBSHMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3160
Mailing Address - Country:US
Mailing Address - Phone:941-492-4462
Mailing Address - Fax:941-492-4497
Practice Address - Street 1:1868 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3160
Practice Address - Country:US
Practice Address - Phone:941-492-4462
Practice Address - Fax:941-492-4497
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA21005OtherFLORIDA LICENSE NUMBER