NPI 1124123872

Jacob David Ibey, ATC

Practitioner Athletic Trainer Enfield, CT

Practice location

Address: 3 Weymouth Rd, Enfield, CT 06082
Phone: (860) 763-7625
Fax: (860) 272-2912
Mailing address: 58 Giddings Ave, Windsor, CT 06095-3702

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 000021 (CT)

Other Specialist/Technologist providers in Connecticut →

Registry record

NPI: 1124123872
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Sep 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.