Provider Demographics
NPI:1588422802
Name:HIBBERT, JUSTIN ONTEZ (MES-A)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ONTEZ
Last Name:HIBBERT
Suffix:
Gender:M
Credentials:MES-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21811 REDWOOD BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7410
Mailing Address - Country:US
Mailing Address - Phone:281-795-5090
Mailing Address - Fax:
Practice Address - Street 1:15377 MEMORIAL DR STE 137
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4141
Practice Address - Country:US
Practice Address - Phone:281-795-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner