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General NPI Number Information
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NPI Number | 1689192577
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Entity Type | Individual
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Provider Name | NICOLE JOY OBERDORF PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 134 LEATHERLEAF DR
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City | BUDA
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State | TX
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Zip | 78610-4022
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Country | US
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Telephone | 920-960-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 134 LEATHERLEAF DR
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City | BUDA
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State | TX
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Zip | 78610-4022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1304196
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License Number State | TX
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