Provider Demographics
NPI:1104008754
Name:ROBINSONDILLARD, RENITA C (PT)
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:C
Last Name:ROBINSONDILLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RENITA
Other - Middle Name:C
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:800-232-3550
Mailing Address - Fax:
Practice Address - Street 1:40000 GRAND RIVER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2121
Practice Address - Country:US
Practice Address - Phone:734-326-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist