Provider Demographics
NPI:1508020934
Name:GOBER, STEPHEN III (ATC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:GOBER
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 STADIUM PKWY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8001
Mailing Address - Country:US
Mailing Address - Phone:321-633-9224
Mailing Address - Fax:321-633-9216
Practice Address - Street 1:5600 STADIUM PKWY
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8001
Practice Address - Country:US
Practice Address - Phone:321-633-9224
Practice Address - Fax:321-633-9216
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 15522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer