Provider Demographics
NPI:1609341791
Name:ROBINSON, BREANNA AUDREY
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:AUDREY
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1137
Mailing Address - Country:US
Mailing Address - Phone:888-531-2204
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:1364 MAIN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-1137
Practice Address - Country:US
Practice Address - Phone:888-531-2204
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9491225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant