Provider Demographics
NPI:1831637826
Name:ROBINSON, TAMELIA (LPTA)
Entity Type:Individual
Prefix:
First Name:TAMELIA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E BAY ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-2815
Mailing Address - Country:US
Mailing Address - Phone:601-783-0220
Mailing Address - Fax:601-783-0222
Practice Address - Street 1:335 E BAY ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2815
Practice Address - Country:US
Practice Address - Phone:601-783-0220
Practice Address - Fax:601-783-0222
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4522225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS468059Medicare PIN