Healthcare Provider Details

I. General information

NPI: 1750413670
Provider Name (Legal Business Name): ELIZABETH MARILYN HOBBS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700A N. KENTUCKY AVE EVANSVILLE NORTH -PHR
EVANSVILLE IN
47725
US

IV. Provider business mailing address

220 CHRIST RD
EVANSVILLE IN
47711-2208
US

V. Phone/Fax

Practice location:
  • Phone: 812-437-2893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002872A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: