Provider Demographics
NPI:1871844670
Name:ROBINSON, GARRY L (LMBT)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N ROBERTS AVE STE 102A
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2285
Mailing Address - Country:US
Mailing Address - Phone:910-738-2930
Mailing Address - Fax:910-738-2932
Practice Address - Street 1:700 N ROBERTS AVE STE 102A
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2285
Practice Address - Country:US
Practice Address - Phone:910-738-2930
Practice Address - Fax:910-738-2932
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist