Provider Demographics
NPI:1801181870
Name:WIRTH, BOBBIE B (LMT)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:B
Last Name:WIRTH
Suffix:
Gender:F
Credentials:LMT
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 245
Mailing Address - Street 2:
Mailing Address - City:SPARR
Mailing Address - State:FL
Mailing Address - Zip Code:32192-0245
Mailing Address - Country:US
Mailing Address - Phone:352-653-8026
Mailing Address - Fax:
Practice Address - Street 1:519 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0997
Practice Address - Country:US
Practice Address - Phone:352-653-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist