Provider Demographics
NPI:1154571537
Name:BIBYK, ROMAN WALTER (PT)
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:WALTER
Last Name:BIBYK
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 1:4660 HINCKLEY INDUSTRIAL PKWY UNIT 7
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-6021
Mailing Address - Country:US
Mailing Address - Phone:216-749-2730
Mailing Address - Fax:
Practice Address - Street 1:4660 HINCKLEY INDUSTRIAL PKWY UNIT 7
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-6021
Practice Address - Country:US
Practice Address - Phone:216-749-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist