Provider Demographics
NPI:1558484295
Name:ROBBINS, IDA PHYLLIS (PT)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:PHYLLIS
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 LOUETTA RD APT 1016
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1429
Mailing Address - Country:US
Mailing Address - Phone:281-320-8012
Mailing Address - Fax:
Practice Address - Street 1:11100 LOUETTA RD APT 1016
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1429
Practice Address - Country:US
Practice Address - Phone:281-320-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1103059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist