Provider Demographics
NPI:1053634568
Name:ROBINSON, LU ANN (PTA, LMT, LMHC)
Entity Type:Individual
Prefix:
First Name:LU
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PTA, LMT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 CAMINO ENTRADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4919
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:505-464-7617
Practice Address - Street 1:2538 CAMINO ENTRADA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4919
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:505-424-1239
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0129621101YM0800X
NM7960225700000X
NM1367225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist