Healthcare Provider Details

I. General information

NPI: 1144845082
Provider Name (Legal Business Name): MICHELLE HOBACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WASHINGTON AVE STE 240
COOKEVILLE TN
38501-2660
US

IV. Provider business mailing address

PO BOX 9118
MINNEAPOLIS MN
55480-9118
US

V. Phone/Fax

Practice location:
  • Phone: 931-854-1203
  • Fax:
Mailing address:
  • Phone: 615-329-2294
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12897
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: