Provider Demographics
NPI:1497183933
Name:STOBBA, CARRIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:STOBBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E MASON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3813
Mailing Address - Country:US
Mailing Address - Phone:414-665-8400
Mailing Address - Fax:414-665-5725
Practice Address - Street 1:633 E MASON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3813
Practice Address - Country:US
Practice Address - Phone:414-665-8400
Practice Address - Fax:414-665-5725
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI105182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic