Provider Demographics
NPI:1629312590
Name:BASS, ROBIN AMANDA (PT)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:AMANDA
Last Name:BASS
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 1:519 8TH ST
Mailing Address - Street 2:4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6910
Mailing Address - Country:US
Mailing Address - Phone:201-993-6973
Mailing Address - Fax:
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-916-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035115-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist