Individual
TIMOTHY KOBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC,CSCS,LMT,CMT
Contact information
Practice address
310 TAUGHANNOCK BVLD, SUITE 5A, ITHACA, NY 14850
(607) 252-3500
Mailing address
2145 MECKLENBURG RD, APT 1, ITHACA, NY 14850-9378
(607) 252-3500
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001623-1
NY
225700000X
Massage Therapist
019227
NY
Other
Enumeration date
04/09/2008
Last updated
04/10/2008
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