Provider Demographics
NPI:1093157273
Name:BOLINGER, ROBERT WILLIAM
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BOLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:WILLIAM
Other - Last Name:BOLINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:746 S MAIN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3333
Mailing Address - Country:US
Mailing Address - Phone:760-728-8999
Mailing Address - Fax:760-728-0821
Practice Address - Street 1:746 S MAIN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3333
Practice Address - Country:US
Practice Address - Phone:760-728-8999
Practice Address - Fax:760-728-0821
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP.T 5352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist