Provider Demographics
NPI:1366475337
Name:HOBUSCH, FREDERICK L (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:L
Last Name:HOBUSCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 S 4015 W
Mailing Address - Street 2:#7
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4437
Mailing Address - Country:US
Mailing Address - Phone:801-967-6055
Mailing Address - Fax:801-967-6934
Practice Address - Street 1:5547 S 4015 W
Practice Address - Street 2:#7
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-4429
Practice Address - Country:US
Practice Address - Phone:801-967-6055
Practice Address - Fax:801-967-6934
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1078932401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107000733102OtherIHC
UT1720OtherPEHP
UT283376OtherDMBA
UT650014593OtherRAILROAD MEDICARE
UT190100500OtherOWCP
UT6400182OtherUHC
UTNO259Medicaid
UT3363451001OtherCIGNA
UT42671OtherFIRST HEALTH
UTQM0000076206OtherALTIUS
UT42671OtherFIRST HEALTH
UT000006567Medicare ID - Type Unspecified