Provider Demographics
NPI:1710197546
Name:BOBBITT, NYNICA SHEVONNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NYNICA
Middle Name:SHEVONNE
Last Name:BOBBITT
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 1:7770 FORDING BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6343
Mailing Address - Country:US
Mailing Address - Phone:336-754-3161
Mailing Address - Fax:
Practice Address - Street 1:1987 HILTON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2968
Practice Address - Country:US
Practice Address - Phone:336-226-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist