Provider Demographics
NPI:1629883731
Name:SIBILLE, ROSS VINCENT (PT)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:VINCENT
Last Name:SIBILLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 KALISTE SALOOM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7164
Mailing Address - Country:US
Mailing Address - Phone:337-981-4053
Mailing Address - Fax:
Practice Address - Street 1:2727 KALISTE SALOOM RD STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7164
Practice Address - Country:US
Practice Address - Phone:337-981-4053
Practice Address - Fax:337-981-4053
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist