Provider Demographics
NPI:1174687503
Name:ROBINSON, IAN MACAULAY (PT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:MACAULAY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 LINDERO CANYON RD
Mailing Address - Street 2:# 506
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-5457
Mailing Address - Country:US
Mailing Address - Phone:805-358-0215
Mailing Address - Fax:805-214-9927
Practice Address - Street 1:1000 NEWBURY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6435
Practice Address - Country:US
Practice Address - Phone:805-358-0215
Practice Address - Fax:805-214-9927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 15149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist