Healthcare Provider Details

I. General information

NPI: 1154395812
Provider Name (Legal Business Name): CHRISTOPHER KIRTLAND HOBLER RSA-O, OPA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TRUMANSBURG RD SUITE R
ITHACA NY
14850-1397
US

IV. Provider business mailing address

1295 STATE ROUTE 13
HORSEHEADS NY
14845-7252
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-7000
  • Fax: 607-272-4604
Mailing address:
  • Phone: 607-272-7000
  • Fax: 607-272-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000058-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0000171
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number00000171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: