Provider Demographics
NPI:1396228060
Name:ROBINSON, JETAUN M (LMT)
Entity Type:Individual
Prefix:
First Name:JETAUN
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 BETTY LANE DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1019
Mailing Address - Country:US
Mailing Address - Phone:734-272-8423
Mailing Address - Fax:
Practice Address - Street 1:591 BETTY LANE DR
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1019
Practice Address - Country:US
Practice Address - Phone:734-272-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist