Provider Demographics
NPI:1346892544
Name:MURRY, ROBIN ALICIA (LPTA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ALICIA
Last Name:MURRY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 OVETT PETAL RD
Mailing Address - Street 2:
Mailing Address - City:OVETT
Mailing Address - State:MS
Mailing Address - Zip Code:39464-3459
Mailing Address - Country:US
Mailing Address - Phone:601-543-9972
Mailing Address - Fax:
Practice Address - Street 1:217 METHODIST BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1338
Practice Address - Country:US
Practice Address - Phone:601-329-2233
Practice Address - Fax:601-329-2232
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA1983225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant