Basic Information
| Provider Information | |||||||||
| NPI: | 1013660216 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WOBBE | ||||||||
| FirstName: | ABIGAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 N MAIN ST | ||||||||
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| City: | SHILOH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622692970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189718149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1623 W DELMAR AVE | ||||||||
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| City: | GODFREY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620351317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184660443 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2022 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160.009357 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.