Provider Demographics
NPI:1447687785
Name:KOBER, SHAWNA MAY (DPT)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MAY
Last Name:KOBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELM ST
Mailing Address - Street 2:BOX 292
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-7738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 ELM ST
Practice Address - Street 2:BOX 292
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809-7738
Practice Address - Country:US
Practice Address - Phone:518-744-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208327225100000X
NY036795225100000X
MD24720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist