Timothy Koba, ATC,CSCS,LMT,CMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

001623-1 Issued in NY

Practice address

310 Taughannock BVLD
Suite 5a
Ithaca, NY 14850

Phone

(607) 252-3500

NPI assigned

Apr 9, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207785600000",
    "number": "1578736799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 MECKLENBURG RD",
            "address_2": "APT 1",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148509378",
            "telephone_number": "607-252-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 TAUGHANNOCK BVLD",
            "address_2": "SUITE 5A",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-252-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBA",
        "first_name": "TIMOTHY",
        "credential": "ATC,CSCS,LMT,CMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "019227",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "001623-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Klingensmith, LCAT, MT-BC
• Jon W Kloppel
• Eric Knaake, MSN, CRNP, FNP-C
• Daniel J Knauer, PHD
• Lucas Knewstub
• Lavanya Kodali, M.D
• Sarah Kohberger
• Dianea Alice Kohl, RN,MFT
• Taylor Kolniak, MS, ATC
• Katarzyna Zofia Komorowska, DC

• All providers in Ithaca, NY
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.