Provider Demographics
NPI:1689694804
Name:BURT, ROBYN LEE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:LEE
Last Name:BURT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SLEEPY FAWN PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-7829
Mailing Address - Country:US
Mailing Address - Phone:662-245-1541
Mailing Address - Fax:
Practice Address - Street 1:2623 5TH ST N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2009
Practice Address - Country:US
Practice Address - Phone:662-328-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT01832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer