Provider Demographics
NPI:1619373438
Name:ROBINSON, KERRIE (PTA)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:ROBINSON
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 1:1322 E HARVEST LANE CIR
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8504
Mailing Address - Country:US
Mailing Address - Phone:316-641-7427
Mailing Address - Fax:
Practice Address - Street 1:6803 W TAFT AVE
Practice Address - Street 2:#300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2364
Practice Address - Country:US
Practice Address - Phone:316-347-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant