Provider Demographics
NPI:1497426167
Name:HOBBES, GRACE POPHAM (MS, ATC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:POPHAM
Last Name:HOBBES
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:HIGGINS
Other - Last Name:POPHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CUNNINGHAM SQ
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02918-7001
Mailing Address - Country:US
Mailing Address - Phone:401-865-1752
Mailing Address - Fax:
Practice Address - Street 1:110 ROME AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1227
Practice Address - Country:US
Practice Address - Phone:401-499-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT003772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer