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General NPI Number Information
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NPI Number | 1821623737
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Entity Type | Organization
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Legal Business Name | COBALT THERAPY, LLC
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 510 CO RD 466 SUITE 204-E AND 203-L
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City | LADY LAKE
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State | FL
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Zip | 32159-4202
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Country | US
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Telephone | 352-508-7789
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Fax | 352-855-0459
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Provider Business Mailing Address
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Address Line | 1303 LIMIT AVE STE 201
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City | MOUNT DORA
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State | FL
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Zip | 32757-3135
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Country | US
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Telephone | 352-818-7368
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Fax | 352-855-0459
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. ANN-MARIE A DYKSTRA
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Credential | MA, CCC-SLP
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Telephone | 352-508-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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