Healthcare Provider Details

I. General information

NPI: 1063678472
Provider Name (Legal Business Name): JUSTIN SCHOBER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COULEE BOULEVARD WEST
ELECTRIC CITY WA
99123
US

IV. Provider business mailing address

201 E ANSEL AVE
BREWSTER WA
98812-9609
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-9915
  • Fax: 888-316-6792
Mailing address:
  • Phone: 509-429-3355
  • Fax: 888-316-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00008835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: