Healthcare Provider Details

I. General information

NPI: 1710291448
Provider Name (Legal Business Name): MAIMI KOBAYASHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 BEVILLE RD STE G
SOUTH DAYTONA FL
32119-1712
US

IV. Provider business mailing address

383 DOUGLAS RD
ROSELLE NJ
07203-3012
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-7711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01182300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: