Provider Demographics
NPI:1427207091
Name:ROBINSON, JACQUELYN OLIVIA (PTA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:OLIVIA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-3355
Mailing Address - Country:US
Mailing Address - Phone:484-769-7480
Mailing Address - Fax:
Practice Address - Street 1:36 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-3355
Practice Address - Country:US
Practice Address - Phone:484-769-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002138-L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant