Provider Demographics
NPI:1669597985
Name:LIBRE-SABIO, SIMMONETTE PONFERRADA (PT)
Entity type:Individual
Prefix:MRS
First Name:SIMMONETTE
Middle Name:PONFERRADA
Last Name:LIBRE-SABIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 N GORSKI LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-4120
Mailing Address - Country:US
Mailing Address - Phone:215-699-8727
Mailing Address - Fax:215-699-2568
Practice Address - Street 1:8000 TWIN SILO DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-4200
Practice Address - Country:US
Practice Address - Phone:215-699-8727
Practice Address - Fax:215-699-2568
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010043L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist