Provider Demographics
NPI:1184231201
Name:COBANE, RUSSELL (DPT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:COBANE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 USHERS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1428
Mailing Address - Country:US
Mailing Address - Phone:518-871-9097
Mailing Address - Fax:518-869-6465
Practice Address - Street 1:258 USHERS RD STE 100
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1428
Practice Address - Country:US
Practice Address - Phone:518-871-9097
Practice Address - Fax:518-869-6465
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046327261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy