Provider Demographics
NPI:1235508284
Name:ROBINSON, KELLIE ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:317 N EL CAMINO REAL STE 210
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2813
Mailing Address - Country:US
Mailing Address - Phone:760-634-0248
Mailing Address - Fax:760-634-1782
Practice Address - Street 1:1663 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3520
Practice Address - Country:US
Practice Address - Phone:619-440-5752
Practice Address - Fax:619-440-6861
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist