Provider Demographics
NPI:1447466750
Name:COBBS, JOANNE CHARLOTTE (LMP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:CHARLOTTE
Last Name:COBBS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 KING ROAD
Mailing Address - Street 2:POB 411
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596
Mailing Address - Country:US
Mailing Address - Phone:360-785-7516
Mailing Address - Fax:
Practice Address - Street 1:839 KING ROAD
Practice Address - Street 2:POB 411
Practice Address - City:WINLOCK
Practice Address - State:WA
Practice Address - Zip Code:98596
Practice Address - Country:US
Practice Address - Phone:360-785-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist