Provider Demographics
NPI:1164673547
Name:COFER, KRISTINA KOBBEMAN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:KOBBEMAN
Last Name:COFER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:KOBBEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:7256 W PALATINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1944
Mailing Address - Country:US
Mailing Address - Phone:773-458-3070
Mailing Address - Fax:
Practice Address - Street 1:900 N NORTH BRANCH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4278
Practice Address - Country:US
Practice Address - Phone:773-458-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0013782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer