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General NPI Number Information
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NPI Number | 1962367235
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Entity Type | Individual
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Provider Name | COBY CONTRERAS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 8727 W ARDENE ST STE 102G
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City | BOISE
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State | ID
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Zip | 83709-2627
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Country | US
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Telephone | 208-322-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 8727 W ARDENE ST STE 102G
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City | BOISE
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State | ID
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Zip | 83709-2627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT021369
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License Number State | OH
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