National Provider Identifier
Timothy Koba, ATC, CSCS, LMT, CMT
Timothy Koba, ATC, CSCS, LMT, CMT is listed in the NPPES registry with a primary specialty of Athletic Trainer in Ithaca, NY and a listed phone number of (607) 252-3500.
Profile Overview
- NPI
- 1578736799
- Provider Type
- Individual
- Primary Specialty
- Athletic Trainer
- Enumeration Date
- April 09, 2008
- Last Updated
- April 10, 2008
Practice Location
- 310 Taughannock Bvld
- Suite 5A
- Ithaca, NY 14850
Phone: (607) 252-3500
Mailing Address
- 2145 Mecklenburg RD
- Apt 1
- Ithaca, NY 14850-9378
Specialties
- Athletic Trainer (2255A2300X)
- Massage Therapist (225700000X)
Full Record
- NPI
- 1578736799
- Entity Type
- Individual
- Last Name
- Koba
- First Name
- Timothy
- Credential
- ATC, CSCS, LMT, CMT
- Mailing Street Address
- 2145 Mecklenburg RD
- Mailing Address Line 2
- Apt 1
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-9378
- Mailing Country
- US
- Mailing Phone
- (607) 252-3500
- Practice Street Address
- 310 Taughannock Bvld
- Practice Address Line 2
- Suite 5A
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850
- Practice Country
- US
- Practice Phone
- (607) 252-3500
- Enumeration Date
- April 09, 2008
- Last Updated
- April 10, 2008
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Athletic Trainer (2255A2300X), Massage Therapist (225700000X)