Provider Demographics
NPI:1528114865
Name:CHESTNUT-KOBYRA, PAMELA (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CHESTNUT-KOBYRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:KOBYRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7128 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1019
Mailing Address - Country:US
Mailing Address - Phone:614-734-9777
Mailing Address - Fax:
Practice Address - Street 1:7128 TIMBERVIEW DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1019
Practice Address - Country:US
Practice Address - Phone:614-734-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT - 3374174400000X
IN05006569A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist