Provider Demographics
NPI:1750407359
Name:KOBERNA, TIMOTHY ROBERT (ATC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:KOBERNA
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:222 FAIRBANKS AVE
Mailing Address - Street 2:DEPT. OF KINESIOLOGY HOPE COLLEGE
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3735
Mailing Address - Country:US
Mailing Address - Phone:616-395-7705
Mailing Address - Fax:616-395-7087
Practice Address - Street 1:222 FAIRBANKS AVE
Practice Address - Street 2:DEPT. OF KINESIOLOGY HOPE COLLEGE
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3735
Practice Address - Country:US
Practice Address - Phone:616-395-7705
Practice Address - Fax:616-395-7087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI26010011502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer