Healthcare Provider Details

I. General information

NPI: 1336343953
Provider Name (Legal Business Name): INCREDIBLE KIDS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2754 E VERMONT DR
GILBERT AZ
85297-6326
US

IV. Provider business mailing address

2754 E VERMONT DR
GILBERT AZ
85297-6326
US

V. Phone/Fax

Practice location:
  • Phone: 623-202-4152
  • Fax: 480-988-3629
Mailing address:
  • Phone: 623-202-4152
  • Fax: 480-988-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY ALLEN KOBERSTEIN
Title or Position: OWNER PHYSICAL THERAPIST
Credential: DPT
Phone: 623-202-4152