Healthcare Provider Details

I. General information

NPI: 1578307617
Provider Name (Legal Business Name): MARISSA HOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 S 132ND ST
OMAHA NE
68137-1764
US

IV. Provider business mailing address

221 N 184TH PLZ APT 301
ELKHORN NE
68022-6984
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-7891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4642
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: