Provider Demographics
NPI:1972618965
Name:COBB, MITZI M (PTA)
Entity type:Individual
Prefix:MS
First Name:MITZI
Middle Name:M
Last Name:COBB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 PALM DR APT 7
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-4940
Mailing Address - Country:US
Mailing Address - Phone:239-530-4586
Mailing Address - Fax:
Practice Address - Street 1:999 TRAIL TERRACE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2305
Practice Address - Country:US
Practice Address - Phone:239-649-2222
Practice Address - Fax:239-649-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant