Provider Demographics
NPI:1598246662
Name:BARDWELL, ROBIN CLAIR (PTA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:CLAIR
Last Name:BARDWELL
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 1:70 COUNTY ROAD 1440
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-7323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 HIGHWAY 161 SOUTH
Practice Address - Street 2:
Practice Address - City:HUGHES SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75656
Practice Address - Country:US
Practice Address - Phone:903-639-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2126920225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant