Provider Demographics
NPI:1508807967
Name:ROBESON, JODY S (PT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:S
Last Name:ROBESON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:L
Other - Last Name:SHANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 2805
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-2805
Mailing Address - Country:US
Mailing Address - Phone:830-796-3447
Mailing Address - Fax:830-796-3685
Practice Address - Street 1:3456 STATE HIGHWAY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:830-796-3447
Practice Address - Fax:830-796-3685
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159443174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1159443OtherSTATE LICENSE