Provider Demographics
NPI:1679983191
Name:BOBER, CORRIE ROSE (MS, ATC, CES)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:ROSE
Last Name:BOBER
Suffix:
Gender:F
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SAINT PIERRE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4342
Mailing Address - Country:US
Mailing Address - Phone:281-728-7868
Mailing Address - Fax:
Practice Address - Street 1:1845 E NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4736
Practice Address - Country:US
Practice Address - Phone:281-728-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000160092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer