=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427130707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS L BOBIC LPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 168 S HIGH ST
-----------------------------------------------------
City | CORTLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44410-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-637-0080
-----------------------------------------------------
Fax | 330-637-0010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 LYNDAL ST
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16101-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-658-7432
-----------------------------------------------------
Fax | 330-637-0010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT08736
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------