Provider Demographics
NPI:1689795189
Name:DESROSIERS, ROBYN L (PTA)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:DESROSIERS
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 1:105 LONGHILL AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2912
Mailing Address - Country:US
Mailing Address - Phone:508-674-7984
Mailing Address - Fax:
Practice Address - Street 1:100 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-7724
Practice Address - Country:US
Practice Address - Phone:508-674-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00270225200000X
MA2531225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2531OtherPHYSICAL THERAPIST ASST
RIPTA00270OtherPHYSICAL THERAPY ASST.