Provider Demographics
NPI:1417282716
Name:KOBER, KATHLEEN (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:KOBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:187 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4503
Mailing Address - Country:US
Mailing Address - Phone:301-663-1157
Mailing Address - Fax:301-663-1229
Practice Address - Street 1:187 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 6
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4503
Practice Address - Country:US
Practice Address - Phone:301-663-1157
Practice Address - Fax:301-663-1229
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229719ZFP1Medicare PIN
DC233852ZFPZMedicare PIN