Provider Demographics
NPI:1164005328
Name:NEVOLE, ROBIN LYNNE (ATC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LYNNE
Last Name:NEVOLE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 MOUNTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 MOUNTVIEW DR
Practice Address - Street 2:CENTENNIAL HIGH SCHOOL
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1431
Practice Address - Country:US
Practice Address - Phone:719-253-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty