Provider Demographics
NPI:1174682132
Name:AGNEW, ROBERT LEWIS I (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEWIS
Last Name:AGNEW
Suffix:I
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:136 HILLDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2320
Mailing Address - Country:US
Mailing Address - Phone:415-453-8960
Mailing Address - Fax:
Practice Address - Street 1:99 MONTICELLO ROAD, MOB2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-444-4285
Practice Address - Fax:415-444-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist