Healthcare Provider Details

I. General information

NPI: 1184832602
Provider Name (Legal Business Name): MR. DWAYNE HOBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 N UNIVERSITY DR FIRST FLOOR
TAMARAC FL
33321-2153
US

IV. Provider business mailing address

8010 N UNIVERSITY DR FIRST FLOOR
TAMARAC FL
33321-2153
US

V. Phone/Fax

Practice location:
  • Phone: 954-724-5500
  • Fax: 954-724-5131
Mailing address:
  • Phone: 954-724-5500
  • Fax: 954-724-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: