Provider Demographics
NPI:1205502911
Name:HIBBS, AUSTIN SKYLER
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:SKYLER
Last Name:HIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11804 E 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5972
Mailing Address - Country:US
Mailing Address - Phone:509-209-3577
Mailing Address - Fax:
Practice Address - Street 1:1203 W FRANCIS AVE # 6640
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6640
Practice Address - Country:US
Practice Address - Phone:509-328-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61199603225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist