Provider Demographics
NPI:1356820039
Name:ROBINSON, REUBEN EDWARD (LMT)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:EDWARD
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 16TH AVENUE CT S APT 8
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-7007
Mailing Address - Country:US
Mailing Address - Phone:253-442-4652
Mailing Address - Fax:
Practice Address - Street 1:10603 16TH AVENUE CT S APT 8
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-442-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60876387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist