Provider Demographics
NPI:1518261668
Name:LOBERG, CHAD L (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:L
Last Name:LOBERG
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 N 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2484
Mailing Address - Country:US
Mailing Address - Phone:775-777-0901
Mailing Address - Fax:775-777-0923
Practice Address - Street 1:2213 N 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2484
Practice Address - Country:US
Practice Address - Phone:775-777-0901
Practice Address - Fax:775-777-0923
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic