Provider Demographics
NPI:1770258626
Name:ROBINSON, EDWARD BRYAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:BRYAN
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6779
Mailing Address - Country:US
Mailing Address - Phone:803-201-1099
Mailing Address - Fax:
Practice Address - Street 1:865 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6779
Practice Address - Country:US
Practice Address - Phone:971-384-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OR64225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist