Healthcare Provider Details

I. General information

NPI: 1184032401
Provider Name (Legal Business Name): KIMBERLY KOBACKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 LANGLEY AVE
PENSACOLA FL
32504-8922
US

IV. Provider business mailing address

3720 HIDDEN OAK DR
PENSACOLA FL
32504-8411
US

V. Phone/Fax

Practice location:
  • Phone: 850-776-3596
  • Fax:
Mailing address:
  • Phone: 850-776-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number70783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: