Provider Demographics
NPI:1063043495
Name:TOBER, FREDERICK WILLIAM (PTA)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:WILLIAM
Last Name:TOBER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23123 CAMDEN WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2446
Mailing Address - Country:US
Mailing Address - Phone:301-862-5177
Mailing Address - Fax:
Practice Address - Street 1:23123 CAMDEN WAY
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2446
Practice Address - Country:US
Practice Address - Phone:301-862-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5088225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant