Provider Demographics
NPI:1780481432
Name:HOBAUGH, HOLLY A (LMT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:HOBAUGH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4269
Mailing Address - Country:US
Mailing Address - Phone:575-838-1000
Mailing Address - Fax:575-838-2000
Practice Address - Street 1:911 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4269
Practice Address - Country:US
Practice Address - Phone:575-838-1000
Practice Address - Fax:575-838-2000
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM9597225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist