Provider Demographics
NPI:1265644496
Name:ROBINSON, KEVIN DWAYNE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DWAYNE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 WELSFORD
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3936
Mailing Address - Country:US
Mailing Address - Phone:254-709-1952
Mailing Address - Fax:254-710-3377
Practice Address - Street 1:1107 WELSFORD
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3936
Practice Address - Country:US
Practice Address - Phone:254-709-1952
Practice Address - Fax:254-710-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT26752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer