Provider Demographics
NPI:1184032401
Name:KOBACKER, KIMBERLY (LMT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:KOBACKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 HIDDEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8411
Mailing Address - Country:US
Mailing Address - Phone:850-776-3596
Mailing Address - Fax:
Practice Address - Street 1:2401 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8922
Practice Address - Country:US
Practice Address - Phone:850-776-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70783172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist