Provider Demographics
NPI:1417927831
Name:KELLOGG, ROBERT MICHAEL (PT PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:PT PHD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:U.S. NAVAL HOSPITAL ROTA SPAIN
Mailing Address - Street 2:PSC 819 BOX 18
Mailing Address - City:ROTA
Mailing Address - State:CADIZ
Mailing Address - Zip Code:FPO AE 09645
Mailing Address - Country:ES
Mailing Address - Phone:3495-682-3500
Mailing Address - Fax:3495-682-3306
Practice Address - Street 1:U.S. NAVAL HOSPITAL ROTA SPAIN
Practice Address - Street 2:PSC 819 BOX 18
Practice Address - City:ROTA
Practice Address - State:CADIZ
Practice Address - Zip Code:FPO AE 09645
Practice Address - Country:ES
Practice Address - Phone:3495-682-3500
Practice Address - Fax:3495-682-3306
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12440225100000X
CA000252251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical