Provider Demographics
NPI:1134691843
Name:DOBBS, JAIME (PTA)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:DOBBS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2302
Mailing Address - Country:US
Mailing Address - Phone:712-898-2006
Mailing Address - Fax:
Practice Address - Street 1:410 BALL PARK RD
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-7243
Practice Address - Country:US
Practice Address - Phone:402-755-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091040225200000X
NE1741225200000X
SD0556225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant