Provider Demographics
NPI:1184802696
Name:BOBOLA, JOHN S
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:BOBOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 W 112TH CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-7812
Mailing Address - Country:US
Mailing Address - Phone:303-469-3111
Mailing Address - Fax:
Practice Address - Street 1:4800 W 112TH CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7812
Practice Address - Country:US
Practice Address - Phone:303-469-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist