Provider Demographics
NPI:1639777642
Name:ROBINSON, TYKIA DESHEA
Entity Type:Individual
Prefix:
First Name:TYKIA
Middle Name:DESHEA
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 1:5904 LEABROOK LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4168
Mailing Address - Country:US
Mailing Address - Phone:501-960-0722
Mailing Address - Fax:
Practice Address - Street 1:5904 LEABROOK LN
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4168
Practice Address - Country:US
Practice Address - Phone:501-960-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4575225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant