Provider Demographics
NPI:1568104974
Name:ROBINSON, JAMES SCOTT (LMT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SCOTT
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W BARRY AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7473
Mailing Address - Country:US
Mailing Address - Phone:678-756-6605
Mailing Address - Fax:
Practice Address - Street 1:2860 N BROADWAY ST FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6017
Practice Address - Country:US
Practice Address - Phone:678-756-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227022329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist