Provider Demographics
NPI:1962041079
Name:HIBBERT, JAMIE ELIZABETH (PHD, ATC, CSCS, CES)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:PHD, ATC, CSCS, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 OLIPHANT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1732
Mailing Address - Country:US
Mailing Address - Phone:617-835-7365
Mailing Address - Fax:
Practice Address - Street 1:333 S TWIN OAKS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92096-0001
Practice Address - Country:US
Practice Address - Phone:617-835-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer