Provider Demographics
NPI:1306855606
Name:EWEY, ROBERT DESMOND (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DESMOND
Last Name:EWEY
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 1:1549 MANASCO CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7348
Mailing Address - Country:US
Mailing Address - Phone:916-983-2779
Mailing Address - Fax:
Practice Address - Street 1:2305 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4337
Practice Address - Country:US
Practice Address - Phone:916-632-9606
Practice Address - Fax:916-632-9706
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 4307225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant