Provider Demographics
NPI:1063655579
Name:BOBO, WILLIAM PARKER (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PARKER
Last Name:BOBO
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-3079
Mailing Address - Country:US
Mailing Address - Phone:936-559-1213
Mailing Address - Fax:
Practice Address - Street 1:3304 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-3079
Practice Address - Country:US
Practice Address - Phone:936-559-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT30132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer