Provider Demographics
NPI:1932457108
Name:FOBBS, MARQUES A SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:MARQUES
Middle Name:A
Last Name:FOBBS
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 HAIGS CRK N
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8328
Mailing Address - Country:US
Mailing Address - Phone:803-718-2164
Mailing Address - Fax:803-729-4232
Practice Address - Street 1:264 HAIGS CRK N
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8328
Practice Address - Country:US
Practice Address - Phone:803-718-2164
Practice Address - Fax:803-729-4232
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist