Provider Demographics
NPI:1417437179
Name:RAPP, ROBIN L (MT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:RAPP
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N GROSS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6277
Mailing Address - Country:US
Mailing Address - Phone:912-576-9849
Mailing Address - Fax:912-576-5180
Practice Address - Street 1:130 N GROSS RD STE 206
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6277
Practice Address - Country:US
Practice Address - Phone:912-576-9849
Practice Address - Fax:912-576-5180
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMT012300OtherLISCENSE