Basic Information
Provider Information
NPI: 1285381954
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOBBS
FirstName: SARAH
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HOBBS
OtherFirstName: SARAH
OtherMiddleName: L
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PTA
OtherLastNameType: 5
Mailing Information
Address1: 225 CLEARFIELD AVE
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234621815
CountryCode: US
TelephoneNumber: 7574575100
FaxNumber:  
Practice Location
Address1: 225 CLEARFIELD AVE
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234621815
CountryCode: US
TelephoneNumber: 7574575100
FaxNumber: 7579613696
Other Information
ProviderEnumerationDate: 03/03/2022
LastUpdateDate: 03/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X2306602341VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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