Active NPI
Moira Sibbaluca
- Physical Therapist
- Peru, IL
National Provider Identifier
1184030900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070014061
- Practice address
- 4231 Progress Blvd
Peru, IL 61354-1193 - Phone
- (815) 326-5924
- NPI assigned
- Jul 2, 2014
- Last updated
- Jul 2, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070014061 | IL | Primary |
Addresses
Primary practice location
4231 Progress Blvd
Peru, IL 61354-1193
Mailing address
120 Rominer Circle
Dazell, IL 61320
Phone (815) 326-5924
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070014061 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Home Bound Healthcare, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Home Health Agency
- Sycamore, IL
- NPI 1952553133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404259200000",
"number": "1184030900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 ROMINER CIRCLE",
"city": "DAZELL",
"state": "IL",
"postal_code": "61320",
"telephone_number": "815-326-5924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4231 PROGRESS BLVD",
"city": "PERU",
"state": "IL",
"postal_code": "613541193",
"telephone_number": "815-326-5924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIBBALUCA",
"first_name": "MOIRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-02",
"last_updated": "2014-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070014061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.