Provider Demographics
NPI:1427000892
Name:TOBUREN, DAVID L (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:TOBUREN
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 1:3026 OVERLOOK HILL PASS
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5105
Mailing Address - Country:US
Mailing Address - Phone:678-376-7547
Mailing Address - Fax:
Practice Address - Street 1:3026 OVERLOOK HILL PASS
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5105
Practice Address - Country:US
Practice Address - Phone:678-376-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAP1004866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist