Provider Demographics
NPI:1780979781
Name:TIBBILS, DONALD MARC (PTA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MARC
Last Name:TIBBILS
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Gender:M
Credentials:PTA
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Mailing Address - Street 1:3760 CONVOY STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-514-0375
Mailing Address - Fax:858-514-0383
Practice Address - Street 1:3760 CONVOY STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:858-514-0375
Practice Address - Fax:858-514-0383
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAT5528225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant