MEDICARE: KATHLENE BOBBITT

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	225100000X	Physical Therapist	PT33774	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912487026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLENE BOBBITT

Provider Business Mailing Address
First Line	:	1571 WALNUT CREEK DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-7428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 EASTWEST PKWY STE 12
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-5310
Country	:	US
Telephone Number	:	904-215-3958
Fax Number	:

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

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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Directions to “ KATHLENE BOBBITT ” Practice Location

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