Provider Demographics
NPI:1881029312
Name:KOBLOSH, MELINDA A (PT)
Entity type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:A
Last Name:KOBLOSH
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 1:1111 ELM ST.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-736-2250
Mailing Address - Fax:413-736-2254
Practice Address - Street 1:1111 ELM ST.
Practice Address - Street 2:SUITE 9
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-736-2250
Practice Address - Fax:413-736-2254
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist