Provider Demographics
NPI:1346000536
Name:ROBINSON, MIKAELA MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:MARIE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 EDGEWOOD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6484
Mailing Address - Country:US
Mailing Address - Phone:832-326-0157
Mailing Address - Fax:
Practice Address - Street 1:5610 EDGEWOOD PLACE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6484
Practice Address - Country:US
Practice Address - Phone:832-326-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer