Provider Demographics
NPI:1073173258
Name:LIBBY, JINA (DO)
Entity type:Individual
Prefix:
First Name:JINA
Middle Name:
Last Name:LIBBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:MC CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:610-208-4648
Mailing Address - Fax:
Practice Address - Street 1:1850 E PARK AVE STE 112
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-865-3566
Practice Address - Fax:142-354-7808
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151013974208100000X
PAOS024239207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation