Provider Demographics
NPI:1184086266
Name:BIBEAU, SHAWN CATHERINE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:CATHERINE
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 NEW YORK RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-4425
Mailing Address - Country:US
Mailing Address - Phone:518-324-8180
Mailing Address - Fax:
Practice Address - Street 1:279 NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-4425
Practice Address - Country:US
Practice Address - Phone:518-324-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021460-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist