Provider Demographics
NPI:1417622986
Name:ROBINSON, JACOB (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273-1021
Mailing Address - Country:US
Mailing Address - Phone:903-818-9421
Mailing Address - Fax:
Practice Address - Street 1:2400 W PIONEER PKWY STE 108
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-6091
Practice Address - Country:US
Practice Address - Phone:682-276-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1352028225100000X, 2251S0007X
TX3127700225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty