Provider Demographics
NPI:1760881643
Name:FEEBACK, BOBBY (ATC)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:FEEBACK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GRAPEVINE MILLS PKWY
Mailing Address - Street 2:APT 3237
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1989
Mailing Address - Country:US
Mailing Address - Phone:859-588-5582
Mailing Address - Fax:
Practice Address - Street 1:1 COWBOYS PKWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4924
Practice Address - Country:US
Practice Address - Phone:859-588-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer