Provider Demographics
NPI:1437368321
Name:JACKMAN, ROBIN L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:L
Last Name:JACKMAN
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 1:633 GIBSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:CPU SUMMIT GENERAL STORE
Mailing Address - State:RI
Mailing Address - Zip Code:02827-1901
Mailing Address - Country:US
Mailing Address - Phone:401-397-5413
Mailing Address - Fax:
Practice Address - Street 1:735 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1435
Practice Address - Country:US
Practice Address - Phone:401-949-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0040225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant