Provider Demographics
NPI:1093205379
Name:NALL, ROBYN MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:MARIE
Last Name:NALL
Suffix:
Gender:F
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 1:39W308 BAERT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7735
Mailing Address - Country:US
Mailing Address - Phone:847-732-5880
Mailing Address - Fax:
Practice Address - Street 1:1601 E MAIN ST UNIT G
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2431
Practice Address - Country:US
Practice Address - Phone:847-732-5880
Practice Address - Fax:630-454-3555
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist