Active NPI
Larry Lee Libbee, CO
- Orthotist
- Fort Wayne, IN
National Provider Identifier
1871513614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthotist
- License
- CO004903
- Practice address
- 7735 W Jefferson Blvd
Suite C
Fort Wayne, IN 46804-4135 - Phone
- (260) 483-5219
- Fax
- (260) 484-2291
- NPI assigned
- Jul 21, 2006
- 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 |
|---|---|---|---|---|
| Orthotist | 222Z00000X | CO004903 | IN | Primary |
Addresses
Primary practice location
7735 W Jefferson Blvd
Suite C
Fort Wayne, IN 46804-4135
Mailing address
7735 W Jefferson Blvd
Suite C
Fort Wayne, IN 46804-4135
Phone (260) 483-5219
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 |
|---|---|---|---|
| CO004903 | IN | MD | Orthotist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489017600000",
"number": "1871513614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7735 W JEFFERSON BLVD",
"address_2": "SUITE C",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044135",
"telephone_number": "260-483-5219",
"fax_number": "260-484-2291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7735 W JEFFERSON BLVD",
"address_2": "SUITE C",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044135",
"telephone_number": "260-483-5219",
"fax_number": "260-484-2291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBBEE",
"first_name": "LARRY",
"middle_name": "LEE",
"credential": "CO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2017-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "IN",
"license": "CO004903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.