Jacob David Ibey, ATC
Individual provider Active NPI Athletic Trainer · Enfield, CT
NPI 1124123872 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124123872
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 000021 (CT)
- Practice address
- 3 Weymouth Rd
Enfield, CT 06082 - Phone
- (860) 763-7625
- Fax
- (860) 272-2912
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000021 | CT | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 000021 | CT | Yes |
Addresses
Primary practice location
3 Weymouth Rd
Enfield, CT 06082
Mailing address
58 Giddings Ave
Windsor, CT 06095-3702
Phone (860) 687-1459
Other providers in Enfield, CT
- Takima Hurst
- Morica Hutchinson
- Nekeisha Hutchinson
- I Smile Dental Studio, P.C.
- Joseph L Ianello
- Julia Soo Im
- Interanal Medicine and Pediatric Associates LLC
- Interlocking Connections, LLC
- Ira Pollack MD PC
- Michelle Ishler
All providers in Enfield, CT · Athletic Trainer in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.