Provider Demographics
NPI:1528346871
Name:O'BRUBA, MICHAEL R (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:O'BRUBA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4356
Mailing Address - Country:US
Mailing Address - Phone:330-652-1415
Mailing Address - Fax:330-652-1422
Practice Address - Street 1:650 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4356
Practice Address - Country:US
Practice Address - Phone:330-652-1415
Practice Address - Fax:330-652-1422
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHPT013290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist