Provider Demographics
NPI:1427130707
Name:BOBIC, THOMAS L (LPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:BOBIC
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 LYNDAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4920
Mailing Address - Country:US
Mailing Address - Phone:724-658-7432
Mailing Address - Fax:330-637-0010
Practice Address - Street 1:168 S HIGH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1416
Practice Address - Country:US
Practice Address - Phone:330-637-0080
Practice Address - Fax:330-637-0010
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT08736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341877311028OtherCARESOURCE
OH6497047OtherUHC
OH000000329697OtherANTHEM
OH34187731100OtherBWC
OH2536643Medicaid
OH000000218075OtherANTHEM
253581OtherHEALTH AMERICA
OH34187731101OtherBWC
OH341877311028OtherCARESOURCE
BO4132402Medicare ID - Type Unspecified
P00194688Medicare ID - Type Unspecified