Provider Demographics
NPI:1265681712
Name:ROBINSON, LEIF CORNELIUS (PTA)
Entity Type:Individual
Prefix:MR
First Name:LEIF
Middle Name:CORNELIUS
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GOLDEN TIDE AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1337
Mailing Address - Country:US
Mailing Address - Phone:270-977-2961
Mailing Address - Fax:
Practice Address - Street 1:215 GOLDEN TIDE AVE
Practice Address - Street 2:APT. 1
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1337
Practice Address - Country:US
Practice Address - Phone:270-977-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02405314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility