Provider Demographics
NPI:1073643300
Name:BOBO, LINDA STARK (PHD, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:STARK
Last Name:BOBO
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-3079
Mailing Address - Country:US
Mailing Address - Phone:936-559-1213
Mailing Address - Fax:
Practice Address - Street 1:1936 N STREET, HPE COMPLEX, RM 204
Practice Address - Street 2:SFASFU
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75962
Practice Address - Country:US
Practice Address - Phone:936-468-1599
Practice Address - Fax:936-468-1850
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT16652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer