Provider Demographics
NPI:1114986148
Name:COBERLEY, MARK CHRISTOPHER (MS ATC LAT CSCS PES)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:COBERLEY
Suffix:
Gender:M
Credentials:MS ATC LAT CSCS PES
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Mailing Address - Street 1:JACOBSON ATHLETIC COMPLEX, ONE CYCLONE WAY
Mailing Address - Street 2:IOWA STATE UNIVERSITY
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011-0001
Mailing Address - Country:US
Mailing Address - Phone:515-294-4441
Mailing Address - Fax:515-294-6554
Practice Address - Street 1:JACOBSON ATHLETIC COMPLEX, ONE CYCLONE WAY
Practice Address - Street 2:IOWA STATE UNIVERSITY
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-0001
Practice Address - Country:US
Practice Address - Phone:515-294-4441
Practice Address - Fax:515-294-6554
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA1102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer