Provider Demographics
NPI:1275302267
Name:COBB, IMANA LAMANICA
Entity Type:Individual
Prefix:
First Name:IMANA
Middle Name:LAMANICA
Last Name:COBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SHADOWBRIAR DR APT 1420
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3292
Mailing Address - Country:US
Mailing Address - Phone:832-892-1056
Mailing Address - Fax:
Practice Address - Street 1:2840 SHADOWBRIAR DR APT 1420
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3292
Practice Address - Country:US
Practice Address - Phone:832-892-1056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT115056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist