Provider Demographics
NPI:1497059299
Name:ROBINSON, TARENCE LEE
Entity Type:Individual
Prefix:
First Name:TARENCE
Middle Name:LEE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-0870
Mailing Address - Country:US
Mailing Address - Phone:352-490-7500
Mailing Address - Fax:352-490-7110
Practice Address - Street 1:220 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0870
Practice Address - Country:US
Practice Address - Phone:352-490-7500
Practice Address - Fax:352-490-7110
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21673225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant