Provider Demographics
NPI:1114038080
Name:PINKSTON, ROBERT (RPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 W HILLCREST DR
Mailing Address - Street 2:SUITE #117
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4264
Mailing Address - Country:US
Mailing Address - Phone:805-370-5705
Mailing Address - Fax:805-370-5701
Practice Address - Street 1:299 W HILLCREST DR
Practice Address - Street 2:SUITE #117
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4264
Practice Address - Country:US
Practice Address - Phone:805-370-5705
Practice Address - Fax:805-370-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26221Medicare ID - Type UnspecifiedPT #