Healthcare Provider Details

I. General information

NPI: 1659581569
Provider Name (Legal Business Name): BOBBIE BATES SENG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14912 BRICK RD
GRANGER IN
46530
US

IV. Provider business mailing address

14912 BRICK RD
GRANGER IN
46530
US

V. Phone/Fax

Practice location:
  • Phone: 574-315-7220
  • Fax:
Mailing address:
  • Phone: 574-315-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003730
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008360A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: