Provider Demographics
NPI:1043592231
Name:ROBINSON, KIA JOLENE (PT)
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:JOLENE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-1237
Mailing Address - Country:US
Mailing Address - Phone:901-367-0811
Mailing Address - Fax:901-367-9569
Practice Address - Street 1:5570 MURRAY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3805
Practice Address - Country:US
Practice Address - Phone:901-367-0811
Practice Address - Fax:901-367-9569
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT4456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist