Provider Demographics
NPI:1053992867
Name:BODY FORM BY BOBBY
Entity type:Organization
Organization Name:BODY FORM BY BOBBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:830-214-5647
Mailing Address - Street 1:110 OAKTREE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-6852
Mailing Address - Country:US
Mailing Address - Phone:830-214-5647
Mailing Address - Fax:
Practice Address - Street 1:110 OAKTREE ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-6852
Practice Address - Country:US
Practice Address - Phone:830-214-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy