Provider Demographics
NPI:1508435405
Name:BOBALIK, ANN LYNN (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LYNN
Last Name:BOBALIK
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 1:1015 RIVERSIDE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968-1385
Mailing Address - Country:US
Mailing Address - Phone:304-374-3795
Mailing Address - Fax:
Practice Address - Street 1:1015 RIVERSIDE AVE APT B
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43968-1385
Practice Address - Country:US
Practice Address - Phone:304-374-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH45302251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics