Provider Demographics
NPI:1457644775
Name:KOBUS, PAMELA ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:KOBUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6381 MEADOWPOINTE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1974
Mailing Address - Country:US
Mailing Address - Phone:702-459-5157
Mailing Address - Fax:
Practice Address - Street 1:5110 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3406
Practice Address - Country:US
Practice Address - Phone:702-352-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA0166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant