Provider Demographics
NPI:1396336418
Name:KOBUS, MICHAEL A (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:KOBUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LINDEN AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3064
Mailing Address - Country:US
Mailing Address - Phone:937-516-8745
Mailing Address - Fax:
Practice Address - Street 1:4130 LINDEN AVE STE 115
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3064
Practice Address - Country:US
Practice Address - Phone:937-516-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist