Provider Demographics
NPI:1588085120
Name:POBOCIK, ANDREW JOHN (LMT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:POBOCIK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6197 MILLER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1586
Mailing Address - Country:US
Mailing Address - Phone:810-471-0007
Mailing Address - Fax:
Practice Address - Street 1:6197 MILLER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1586
Practice Address - Country:US
Practice Address - Phone:810-471-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2440742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist