Healthcare Provider Details

I. General information

NPI: 1639400849
Provider Name (Legal Business Name): ROBERT KOTRABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HOSPITAL LOOP NE
ALBUQUERQUE NM
87109-2115
US

IV. Provider business mailing address

103 HOSPITAL LOOP NE
ALBUQUERQUE NM
87109-2115
US

V. Phone/Fax

Practice location:
  • Phone: 603-681-9009
  • Fax: 866-420-1055
Mailing address:
  • Phone: 603-681-9009
  • Fax: 866-420-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0021209
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15250
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: