Active NPI
Michael R Bibbo, MS, LAT, ATC, CES
- Athletic Trainer
- Philadelphia, PA
National Provider Identifier
1225544018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RTO000092
- Practice address
- 2450 N 54TH St
Philadelphia, PA 19131-1309 - Phone
- (610) 517-9043
- NPI assigned
- Dec 16, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RTO000092 | PA | Primary |
Addresses
Primary practice location
2450 N 54TH St
Philadelphia, PA 19131-1309
Mailing address
518 Spring Mill Ave
Conshohocken, PA 19428-1950
Phone (610) 517-9043
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RTO000092 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513382400000",
"number": "1225544018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 SPRING MILL AVE",
"city": "CONSHOHOCKEN",
"state": "PA",
"postal_code": "194281950",
"telephone_number": "610-517-9043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 N 54TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311309",
"telephone_number": "610-517-9043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIBBO",
"first_name": "MICHAEL",
"middle_name": "R",
"credential": "MS, LAT, ATC, CES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-16",
"last_updated": "2017-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RTO000092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.