Basic Information
| Provider Information | |||||||||
| NPI: | 1265667612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOBEL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4247 W RIDGE RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165061746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148337249 | ||||||||
| FaxNumber: | 8144527005 | ||||||||
| Practice Location | |||||||||
| Address1: | 4247 W RIDGE RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165061746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148337249 | ||||||||
| FaxNumber: | 8148382661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2009 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT019944 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1023055420001 | 05 | PA | MEDICAID |