Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05002669A | IN |
N | 2251S0007X | Physical Therapist - Sports | 05002669A | IN |
NPI | 1154401925 |
---|---|
Provider Name | David E Cobb |
First Address | Lafayette, IN 47903-4699 |
Second Address | West Lafayette, IN 47906-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 15/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000496786 | ANTHEM (01) | IN |
201164480 | (05) | IN |