1417570284 NPI number — HOLISTIC PT, LLC

Table of content: BOBBI CHRISTINE THACKER ARNP (NPI 1033424924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417570284 NPI number — HOLISTIC PT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC PT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417570284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3926 CONSTANTINE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33543-4913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-255-6005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3926 CONSTANTINE LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33543-4913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-448-3493
Provider Business Practice Location Address Fax Number:
833-224-1104
Provider Enumeration Date:
05/27/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAUL-PUERIE
Authorized Official First Name:
DESANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
470-255-6005

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)