Healthcare Provider Details

I. General information

NPI: 1679088629
Provider Name (Legal Business Name): BRENT KOBS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BUSH ST STE 200
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT STE 325C
SAN FRANCISCO CA
94109-5482
US

V. Phone/Fax

Practice location:
  • Phone: 415-776-1646
  • Fax: 415-776-1964
Mailing address:
  • Phone: 415-776-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: