Provider Demographics
NPI:1780705681
Name:KIBLER, ADAM C (PTA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:C
Last Name:KIBLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 AUMANSON ST NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8444
Mailing Address - Country:US
Mailing Address - Phone:330-297-5781
Mailing Address - Fax:330-297-6921
Practice Address - Street 1:565 BRYN MAWR ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9696
Practice Address - Country:US
Practice Address - Phone:330-297-5781
Practice Address - Fax:330-297-6921
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA3122225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant