MEDICARE: MONICA SHOBERG PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A1731	MN

General Provider Information

NPI Number	:	1659700201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA SHOBERG PTA

Provider Business Mailing Address
First Line	:	1755 WITTINGTON PL
Second Line	:	SUITE 175
City	:	DALLAS
State	:	TX
Zip	:	75234-1927
Country	:	US
Telephone Number	:	866-221-5405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 WITTINGTON PL
Second Line	:	SUITE 175
City	:	DALLAS
State	:	TX
Zip	:	75234-1927
Country	:	US
Telephone Number	:	866-221-5405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	03/04/2016

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Directions to “ MONICA SHOBERG PTA” Practice Location

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