Healthcare Provider Details

I. General information

NPI: 1285566448
Provider Name (Legal Business Name): LAUREN COBB DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 TROY RD STE 120
EDWARDSVILLE IL
62025-2540
US

IV. Provider business mailing address

2122 TROY RD STE 120
EDWARDSVILLE IL
62025-2540
US

V. Phone/Fax

Practice location:
  • Phone: 618-800-4620
  • Fax:
Mailing address:
  • Phone: 618-800-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070039898
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070039898
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: