Provider Demographics
NPI:1255762415
Name:BOBO, ADELINE CHRISTINE (ATC)
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:CHRISTINE
Last Name:BOBO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ADELINE
Other - Middle Name:CHRISTINE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:3517 DUNEDIN DR
Mailing Address - Street 2:APT 103
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5019
Mailing Address - Country:US
Mailing Address - Phone:614-619-0761
Mailing Address - Fax:
Practice Address - Street 1:3517 DUNEDIN DR
Practice Address - Street 2:APT 103
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5019
Practice Address - Country:US
Practice Address - Phone:614-619-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260015572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer