Provider Demographics
NPI:1447005178
Name:TOBIA, DAVIS SR (MS ATC)
Entity type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:
Last Name:TOBIA
Suffix:SR
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ARDEN RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-2401
Mailing Address - Country:US
Mailing Address - Phone:516-449-1297
Mailing Address - Fax:
Practice Address - Street 1:33 ARDEN RD
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-2401
Practice Address - Country:US
Practice Address - Phone:516-449-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000461-012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer