Provider Demographics
NPI:1124301809
Name:COBB, TOSHA (LMT)
Entity type:Individual
Prefix:MRS
First Name:TOSHA
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 MT ZION PKWY
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1478
Mailing Address - Country:US
Mailing Address - Phone:217-864-1127
Mailing Address - Fax:217-864-1187
Practice Address - Street 1:1397 MT ZION PKWY
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1478
Practice Address - Country:US
Practice Address - Phone:217-864-1127
Practice Address - Fax:217-864-1187
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005370225200000X
IL227.014145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant