Timothy Koba, ATC,CSCS,LMT,CMT
Specialist/Technologist, Athletic Trainer in Ithaca, NY. Individual provider (NPI-1).
NPI number1578736799
StatusActive
Last updated in NPPESApr 10, 2008
Details
- NPI
- 1578736799
- Entity type
- Individual (NPI-1)
- Name
- Timothy Koba
- Credential
- ATC,CSCS,LMT,CMT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 9, 2008
- Last updated
- Apr 10, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 001623-1 | NY | Yes |
| 225700000X | Massage Therapist | 019227 | NY |
Practice location
310 Taughannock BvldSuite 5a
Ithaca, NY 14850
Phone 607-252-3500
Mailing address
2145 Mecklenburg RdApt 1
Ithaca, NY 14850-9378
Phone 607-252-3500
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All 76 Athletic Trainer providers in Ithaca · All 2,555 providers in Ithaca
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