Provider Demographics
NPI:1659592830
Name:SOBBA, ELIZABETH (PT, MMT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:SOBBA
Suffix:
Gender:F
Credentials:PT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1793
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937
Mailing Address - Country:US
Mailing Address - Phone:406-212-4294
Mailing Address - Fax:406-578-1271
Practice Address - Street 1:333 BAKER AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2433
Practice Address - Country:US
Practice Address - Phone:406-212-4294
Practice Address - Fax:406-578-1271
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1183PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60951OtherBLUECROSS BLUESHIELD