Provider Demographics
NPI:1730490913
Name:THANKACHAN, ROBINSON
Entity Type:Individual
Prefix:
First Name:ROBINSON
Middle Name:
Last Name:THANKACHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HUGH WALKER DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2696
Mailing Address - Country:US
Mailing Address - Phone:214-334-4415
Mailing Address - Fax:
Practice Address - Street 1:626 HUGH WALKER DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2696
Practice Address - Country:US
Practice Address - Phone:214-334-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1188526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist