Provider Demographics
NPI:1316028905
Name:DEETS, ROBIN M (PT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:DEETS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 OLEANDER AVE.
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952
Mailing Address - Country:US
Mailing Address - Phone:772-466-4100
Mailing Address - Fax:772-464-7346
Practice Address - Street 1:7300 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8221
Practice Address - Country:US
Practice Address - Phone:772-466-4100
Practice Address - Fax:772-464-7346
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4586AMedicare ID - Type Unspecified