Provider Demographics
NPI:1194997569
Name:LIBBERT, JANIECE K
Entity type:Individual
Prefix:MS
First Name:JANIECE
Middle Name:K
Last Name:LIBBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 OVALTINE CT UNIT 2338
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5602
Mailing Address - Country:US
Mailing Address - Phone:352-348-3422
Mailing Address - Fax:
Practice Address - Street 1:2300 OVALTINE CT UNIT 2338
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-5602
Practice Address - Country:US
Practice Address - Phone:352-348-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004754225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant