Provider Demographics
NPI:1184058190
Name:LOBO, MAGNUS JONATHAN (ATC)
Entity type:Individual
Prefix:
First Name:MAGNUS
Middle Name:JONATHAN
Last Name:LOBO
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 1:1304 15TH AVE SW
Mailing Address - Street 2:APT 610
Mailing Address - City:CALGARY
Mailing Address - State:AB
Mailing Address - Zip Code:T3C 0X7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:147 CANADA OLYMPIC RD SW
Practice Address - Street 2:
Practice Address - City:CALGARY
Practice Address - State:AB
Practice Address - Zip Code:T3B 6B7
Practice Address - Country:CA
Practice Address - Phone:403-284-4040
Practice Address - Fax:403-284-5656
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer