Provider Demographics
NPI:1205217882
Name:ROBANCHO, ISAAC-GREGORY HYDE (LMP)
Entity Type:Individual
Prefix:
First Name:ISAAC-GREGORY
Middle Name:HYDE
Last Name:ROBANCHO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2453
Mailing Address - Country:US
Mailing Address - Phone:425-823-1389
Mailing Address - Fax:425-820-3996
Practice Address - Street 1:10600 NE 68TH ST STE C
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7044
Practice Address - Country:US
Practice Address - Phone:425-823-1389
Practice Address - Fax:425-820-3996
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60493092225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist