Healthcare Provider Details

I. General information

NPI: 1457644775
Provider Name (Legal Business Name): PAMELA ANNE KOBUS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 W SAHARA AVE
LAS VEGAS NV
89146-3406
US

IV. Provider business mailing address

6381 MEADOWPOINTE LN
LAS VEGAS NV
89110-1974
US

V. Phone/Fax

Practice location:
  • Phone: 702-352-9260
  • Fax:
Mailing address:
  • Phone: 702-459-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA0166
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: