Provider Demographics
NPI:1780845800
Name:BIBY, DEREK AUSTIN (PT)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:AUSTIN
Last Name:BIBY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1234 WHITEFISH STAGE
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2753
Mailing Address - Country:US
Mailing Address - Phone:406-756-7878
Mailing Address - Fax:406-257-7811
Practice Address - Street 1:1250 BAKER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2955
Practice Address - Country:US
Practice Address - Phone:406-862-5033
Practice Address - Fax:406-862-4933
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist