Provider Demographics
NPI:1881667491
Name:HIBBS, SARAH (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HIBBS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LONGENECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4038
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:1100 E OUTER RD S STE 4
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MO
Practice Address - Zip Code:63435-1702
Practice Address - Country:US
Practice Address - Phone:573-288-5949
Practice Address - Fax:573-288-5755
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012500225100000X
MO2007005530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00276209Medicare PIN
P87726Medicare UPIN
205632Medicare ID - Type Unspecified
IL205632Medicare PIN