Healthcare Provider Details

I. General information

NPI: 1023754454
Provider Name (Legal Business Name): BYRON LEWIS HOBSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605B KIRKWOOD HWY
WILMINGTON DE
19808-5005
US

IV. Provider business mailing address

4605B KIRKWOOD HWY
WILMINGTON DE
19808-5005
US

V. Phone/Fax

Practice location:
  • Phone: 302-994-2912
  • Fax: 302-994-2916
Mailing address:
  • Phone: 302-994-2912
  • Fax: 302-994-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-0000613
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: