Provider Demographics
NPI:1003202789
Name:BALTHROP, ROBBIE LEE (PTA)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:LEE
Last Name:BALTHROP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N FM 1417
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3106
Mailing Address - Country:US
Mailing Address - Phone:903-892-4800
Mailing Address - Fax:903-892-4444
Practice Address - Street 1:2021 N FM 1417
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3106
Practice Address - Country:US
Practice Address - Phone:903-892-4800
Practice Address - Fax:903-892-4444
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2100146225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant