Provider Demographics
NPI:1942476767
Name:COBB, MARILYN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 KIRKWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1295
Mailing Address - Country:US
Mailing Address - Phone:321-591-0166
Mailing Address - Fax:321-952-8111
Practice Address - Street 1:241 7TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3336
Practice Address - Country:US
Practice Address - Phone:321-591-0166
Practice Address - Fax:321-952-8111
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0013168172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist