Provider Demographics
NPI:1194203091
Name:BOBERSKI, ANNE MARGARET
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARGARET
Last Name:BOBERSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 CHARLES BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-4756
Mailing Address - Country:US
Mailing Address - Phone:901-384-3386
Mailing Address - Fax:901-384-3726
Practice Address - Street 1:2805 CHARLES BRYAN RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-4756
Practice Address - Country:US
Practice Address - Phone:901-384-3386
Practice Address - Fax:901-384-3726
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8205OtherTENNESSEE