Healthcare Provider Details

I. General information

NPI: 1265667612
Provider Name (Legal Business Name): RYAN C KOBEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4247 W RIDGE RD STE 104
ERIE PA
16506-1746
US

IV. Provider business mailing address

4247 W RIDGE RD STE 104
ERIE PA
16506-1746
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-7249
  • Fax: 814-838-2661
Mailing address:
  • Phone: 814-833-7249
  • Fax: 814-452-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: