Provider Demographics
NPI:1447995188
Name:IBARRA, ROBERTO BOBBY (BCSI)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:BOBBY
Last Name:IBARRA
Suffix:
Gender:M
Credentials:BCSI
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCSI
Mailing Address - Street 1:81 W KAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6052
Mailing Address - Country:US
Mailing Address - Phone:802-391-4442
Mailing Address - Fax:
Practice Address - Street 1:81 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6052
Practice Address - Country:US
Practice Address - Phone:802-391-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist