Provider Demographics
NPI:1003197880
Name:ROBINSON, DERRON MAURICE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DERRON
Middle Name:MAURICE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4415
Mailing Address - Country:US
Mailing Address - Phone:205-978-7376
Mailing Address - Fax:205-978-0861
Practice Address - Street 1:1860 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5062
Practice Address - Country:US
Practice Address - Phone:205-395-5003
Practice Address - Fax:205-395-5004
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010398225100000X
ALPTH8137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist