Provider Demographics
NPI:1023548393
Name:ROBIN, ADAM L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:L
Last Name:ROBIN
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 1:1620 HIGHWAY 11 N STE E
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2070
Mailing Address - Country:US
Mailing Address - Phone:769-242-2626
Mailing Address - Fax:769-242-2685
Practice Address - Street 1:1620 HIGHWAY 11 N STE E
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2070
Practice Address - Country:US
Practice Address - Phone:769-242-2626
Practice Address - Fax:769-242-2685
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist