Provider Demographics
NPI:1477800183
Name:HOBERG, AMANDA ALICE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALICE
Last Name:HOBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 STUMBO RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1275
Mailing Address - Country:US
Mailing Address - Phone:419-756-2525
Mailing Address - Fax:419-756-7640
Practice Address - Street 1:2170 STUMBO RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1275
Practice Address - Country:US
Practice Address - Phone:419-756-2525
Practice Address - Fax:419-756-7640
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist