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General NPI Number Information
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NPI Number | 1982139341
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Entity Type | Organization
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Legal Business Name | DR. BOBO, LLC
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 820 MARTIN LUTHER KING JR BLVD
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City | SEBRING
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State | FL
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Zip | 33870-3439
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Country | US
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Telephone | 330-573-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 7501 OKEECHOBEE CT
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-7345
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Country | US
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Telephone | 330-573-4722
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Fax |
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Authorized Official
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Title or Position | OWNER/CHAIRMAN
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Name | DR. ANTHONY BOBO
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Credential |
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Telephone | 330-573-4722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | SS1069
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License Number State | FL
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