Provider Demographics
NPI:1184132540
Name:PRITCHETT, COBY BLAKE
Entity type:Individual
Prefix:
First Name:COBY
Middle Name:BLAKE
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 FM 1389 S
Mailing Address - Street 2:
Mailing Address - City:COMBINE
Mailing Address - State:TX
Mailing Address - Zip Code:75159
Mailing Address - Country:US
Mailing Address - Phone:214-682-1982
Mailing Address - Fax:
Practice Address - Street 1:820 FM 1389 S
Practice Address - Street 2:
Practice Address - City:COMBINE
Practice Address - State:TX
Practice Address - Zip Code:75159
Practice Address - Country:US
Practice Address - Phone:214-682-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer