Provider Demographics
NPI:1083104913
Name:COBB, AIJALON J
Entity Type:Individual
Prefix:
First Name:AIJALON
Middle Name:J
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4726
Mailing Address - Country:US
Mailing Address - Phone:407-514-3657
Mailing Address - Fax:407-381-1971
Practice Address - Street 1:1900 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4726
Practice Address - Country:US
Practice Address - Phone:407-514-3657
Practice Address - Fax:407-381-1971
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT336932251X0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty