Provider Demographics
NPI:1275034662
Name:WADE, KOBEE WEST (DPT)
Entity Type:Individual
Prefix:MR
First Name:KOBEE
Middle Name:WEST
Last Name:WADE
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:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-1010
Mailing Address - Country:US
Mailing Address - Phone:775-726-3171
Mailing Address - Fax:775-726-3118
Practice Address - Street 1:820 N SPRING ST, STE C
Practice Address - Street 2:
Practice Address - City:CALIENTE
Practice Address - State:NV
Practice Address - Zip Code:89008
Practice Address - Country:US
Practice Address - Phone:775-726-3117
Practice Address - Fax:775-726-3118
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty