Provider Demographics
NPI:1710385349
Name:COBOS-TARIN, ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:COBOS-TARIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13754 RIVERCREST CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3208
Mailing Address - Country:US
Mailing Address - Phone:719-433-8380
Mailing Address - Fax:
Practice Address - Street 1:13754 RIVERCREST CIR
Practice Address - Street 2:APT, SUITE, FLOOR, ETC.
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-8092
Practice Address - Country:US
Practice Address - Phone:719-433-8380
Practice Address - Fax:719-362-4185
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00087032251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20420048Medicaid