Provider Demographics
NPI:1013247956
Name:IBACH, STEPHEN R (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:IBACH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:10855 N 116TH ST
Mailing Address - Street 2:STE 130
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4187
Mailing Address - Country:US
Mailing Address - Phone:480-661-2991
Mailing Address - Fax:480-661-2970
Practice Address - Street 1:10855 N 116TH ST
Practice Address - Street 2:STE 130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4187
Practice Address - Country:US
Practice Address - Phone:480-661-2991
Practice Address - Fax:480-661-2970
Is Sole Proprietor?:No
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZMT08100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist